She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.

Eight months pregnant and in severe pain, a woman named Stephanie visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had assembled in a friend’s yard. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before coming to the ER and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and deliver her child.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

A short time later, on the 12th of November, Stephanie gave birth to a infant weighing 4lb 8oz – premature, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been given a few hours prior to birth.

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

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to achieve the unattainable. An OBGYN told her to “simply” stop using. Even her supplier refused to sell to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The widespread belief that her bond with her newborn would make her stop using 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 long-term illness.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would harm her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to name her baby Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a developing system of centers like this facility is proving a simple point: when families are kept intact, results get better, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.

She left the medical center still in recovery, anxious and doubtful about what would happen next.

At the facility, Stephanie still feared that CPS would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could walk in and separate them.

For the initial fortnight, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence 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 people she loved always found ways to cause pain. She lacked the ability to value herself, not to mention anyone else.

Daily, staff from the center transported her to a treatment center, provided orally. Gradually, she was embracing sobriety.

She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies exposed to substances.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a mentor, stopped by with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, seated on the ground with the exit nearby. She is slender. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there given the chance.

“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could be a mom.”

Methods to address infants affected by substances have been used for a long time.

The assessment tool was created in 1975|