Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.

Eight months pregnant and in severe pain, the expectant mother visited the ER after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had built in a companion's property. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and vomited.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to plan her recovery and deliver her child.

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

“I will go,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was critical, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

After five days, on 12 November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – born before term, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” 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 sick. Not ready for motherhood. Unworthy.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she failed. She felt worthless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her source declined to supply to her when she became visibly pregnant.

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

The widespread belief that her affection for her child would make her stop using only led to increased guilt and self-harm, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was connected to tubes and leads, so tiny she thought she would harm her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, 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 supported as a unit, not apart.

In numerous states, where a baby is identified with infant withdrawal condition frequently, infants are still whisked to NICUs and given drugs 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 families are kept intact, results get better, foster placements fall and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to pick her up.

She stepped out of the hospital still in detox, fearful and unsure about what would follow.

At the care center, Stephanie still worried that CPS would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could enter and remove her child.

For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about survival. Addiction came first; reliance came last.

Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to love herself, much less anyone else.

Every day, staff from the center transported her to a recovery program, given as medication. Over time, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an professional – 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 could parent.

On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. An advocate, a peer support specialist, stopped by with her own children 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 admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She keeps a photo of the moment. She is dressed in black pants and a hoodie, a beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her knee for the other kids to see and they are crowding near, showing interest to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could parent.”

Approaches for managing infants affected by substances have existed for decades.

The assessment tool was established in 1975|