🔗 Share this article

In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and threw up.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had taken the drug before seeking medical help and had just enough time to get treated before she needed to go home to get high again. She thought she still had several weeks to figure out how to get clean and give birth.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

After five days, on 12 November 2022, Stephanie had a baby girl weighing 4lb 8oz – premature, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.

She felt sick. Not ready for motherhood. Not fit.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier declined to supply to her when she became visibly pregnant.

“However, I failed,” she said. “I had to seek support.”

The pervasive expectation that her bond with her newborn would make her recover only led to greater shame and negative self-talk, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was connected to monitors, so small she thought she would harm her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition frequently, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when families are kept intact, results get better, fewer children enter care and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to collect her.

She departed the institution still in recovery, anxious and doubtful about what would follow.

---

At Maddie’s Place, Stephanie still was concerned that CPS would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could enter and take her baby away.

For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about getting by. Substances came first; trust came last.

Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to let her down. She lacked the ability to love herself, let alone anyone else.

Each day, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Over time, she was beginning recovery.

She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all typical problems for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. A support specialist, a peer support specialist, came over with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is clad in casual attire, a cap with a bobble on her head, sitting on the wooden floor with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her lap for the other kids to see and they are crowding near, admiring and touching to the baby.

A young boy, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I would become a mother.”

---

Tools for treating babies with exposure have been used for a long time.

The evaluation method was developed in 1975|