🔗 Share this article

In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after her infection worsened up her legs. Without a job or home, estranged from her family, she resided in a small structure she had constructed in a companion's property. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”

She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had a month remaining to plan her recovery and give birth.

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

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie had a baby girl weighing 4lb 8oz – born before term, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been provided shortly before she gave birth.

She felt sick. Unprepared to be a mother. Undeserving.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she relapsed. She felt worthless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her source declined to supply to her when she became obviously with child.

“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 self-harm, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The baby was taken to the special care nursery. When Stephanie at last met her, she was connected to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to give her child the name after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about a specialized facility, a innovative treatment home where women and their babies are cared for jointly, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like the care home is demonstrating a key fact: when families are kept intact, recovery succeeds, custody cases decrease 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, two staff members came to collect her.

She left the medical center still in recovery, fearful and unsure about what would come next.

---

At Maddie’s Place, Stephanie still feared that CPS would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could walk in and separate them.

For the first two weeks, Stephanie stayed withdrawn. “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; faith came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She was unable to love herself, not to mention anyone else.

Daily, staff from Maddie’s Place transported her to a clinic for methadone, given as medication. Slowly, 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 daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all frequent conditions for babies affected by withdrawal.

When a child recognizes these infants need affection, 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 guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own family in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The young ones stared in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She holds a picture of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a bobble on her head, seated on the ground with the entryway at her back. She is thin. Her posture is humble so you do not see her expression. She is lifting the baby on her knee for the other kids to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, called away to other tasks, that they would be there if they could.

“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could be a mom.”

---

Approaches for managing drug-exposed newborns have been available for years.

The evaluation method was developed in 1975|