🔗 Share this article

Pregnant and experiencing intense discomfort, the expectant mother visited the ER after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and vomited.

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

She had taken the drug before arriving at the hospital and had just enough time to get treated before she needed to go home to use once more. She thought she still had several weeks to plan her recovery and have this baby.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the leg infection was serious, 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 face grave danger.

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 medication that eases withdrawal and is frequently utilized in rehabilitation.

After five days, on 12 November 2022, Stephanie had a baby girl weighing a small weight – premature, small but alive.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given a few hours prior to birth.

She felt ill. Not ready for motherhood. Undeserving.

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her source declined to supply to her when she became visibly pregnant.

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

The common assumption that her affection for her child would make her quit only led to greater shame and negative self-talk, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.

The baby was taken to the NICU. When Stephanie at last met her, she was connected to medical equipment, so small she thought she would hurt her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and medicated while their mothers face parental assessments. But a limited but expanding group of centers like the care home is proving a simple point: when parents and infants remain united, 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 ultimately reached out. After confirming she would be a good fit for the program, two staff members came to collect her.

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

---

At the care center, Stephanie still worried that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any time, 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 was suspicious at that point.”

Life on the streets, she said, was about survival. Substances came first; reliance came last.

Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to let her down. She was unable to value herself, let alone anyone else.

Every day, staff from the facility drove her to a recovery program, given as medication. Gradually, she was embracing sobriety.

She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an professional – all frequent conditions for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. 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, seated on the ground 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 knee for the children to see and they are gathered around, showing interest to the baby.

One child, eight, asked the moms: “What about the fathers?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if possible.

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

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could parent.”

---

Tools for treating drug-exposed newborns have existed for decades.

The evaluation method was established in 1975|