She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.

Eight months pregnant and in severe pain, a woman named Stephanie visited the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and vomited.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before arriving at the hospital and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to figure out how to get clean and give birth.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

After five days, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – early, tiny yet healthy.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been provided four hours before delivery.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she relapsed. She felt worthless, berating herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.

“Yet I was unable,” she said. “I required assistance.”

The pervasive expectation that her affection for her child would make her recover only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.

The newborn was transferred to the NICU. When Stephanie at last met her, she was connected to monitors, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

After two days she decided to name her baby after her caregiver, after the professional who provided support to her.

Medical personnel told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In much of the US, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like this facility is showing an important truth: when mothers and babies stay together, results get better, fewer children enter care and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to collect her.

She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.

At the facility, Stephanie still worried that child services would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and remove her child.

For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about survival. Addiction came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to care for herself, not to mention anyone else.

Every day, staff from the facility drove her to a recovery program, provided orally. Slowly, she was starting to get clean.

She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an professional – all common issues for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. A support specialist, a mentor, came over with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a cap with a pompom on her head, resting on the floor with the exit nearby. She is thin. Her posture is humble so you miss her features. She is presenting her daughter on her knee for the children to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if they could.

“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could parent.”

Tools for treating babies with exposure have been available for years.

The assessment tool was created in 1975|