Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.

Eight months pregnant and in severe pain, the expectant mother went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had built in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and threw up.

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had only a brief window to get treated before she needed to go home to relapse. She thought she still had several weeks to find a way to become sober and deliver her child.

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 condition in her limbs was critical, but medical staff detected 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.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

A short time later, on the 12th of November, Stephanie had a infant weighing 4lb 8oz – premature, small but alive.

When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered shortly before she gave birth.

She felt unwell. Ill-equipped for parenting. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her source refused to sell to her when she became clearly expecting.

“But I couldn’t,” she said. “I required assistance.”

The common assumption that her affection for her child would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was connected to tubes and leads, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is proving a simple point: when mothers and babies stay together, recovery succeeds, custody cases decrease and future expenses reduce.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to pick her up.

She departed the institution still in detox, scared and uncertain about what would come next.

At the care center, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any point, someone could enter and remove her child.

For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”

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

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to hurt her. She lacked the ability to love herself, let alone anyone else.

Every day, staff from the facility transported her to a clinic for methadone, administered in pill form. Over time, she was starting to get clean.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an professional – all typical problems for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a mentor, came over with her own children in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She keeps a photo of the moment. She is dressed in casual attire, a beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her lap for the young ones to see and they are standing close, admiring and touching to the baby.

A young boy, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the men were occupied, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I would become a mother.”

Approaches for managing drug-exposed newborns have existed for decades.

The assessment tool was established in 1975|