🔗 Share this article

Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the ER after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she lived in a shed she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and became sick.

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

She had taken the drug before coming to the ER and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to plan her recovery and have this baby.

The medical professional intervened. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

After five days, on the 12th of November, Stephanie gave birth to a daughter weighing a small weight – born before term, little but surviving.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.

She felt unwell. Unprepared to be a mother. Unworthy.

Stephanie had tried to get clean several times during pregnancy, and felt awful each time she relapsed. She felt worthless, criticizing herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her source declined to supply to her when she became visibly pregnant.

“But I couldn’t,” she said. “I needed help.”

The widespread belief that her bond with her newborn would make her recover only led to increased guilt and negative self-talk, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was hooked up to tubes and leads, so little she thought she would harm her. Embracing her at last, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

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

Nurses and doctors told her about a care center, a unique recovery environment 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 whisked to NICUs and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, recovery succeeds, foster placements fall and overall savings increase.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.

She stepped out of the hospital still in detox, scared and uncertain about what would come next.

---

At Maddie’s Place, Stephanie still was concerned that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could enter and remove her child.

For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about enduring. Substances 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 did not know how to care for herself, let alone anyone else.

Every day, staff from Maddie’s Place took her to a recovery program, given as medication. Slowly, she was beginning recovery.

She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

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 mentor, stopped by with her own family in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed 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. None of those things mattered to them.”

She keeps a photo of the moment. She is wearing black pants and a hoodie, a beanie with a decoration on her head, sitting on the wooden floor with the door behind her. She is slender. Her face is downcast so you do not see her expression. She is holding Izzie up on her leg for the other kids to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could parent.”

---

Approaches for managing babies with exposure have been used for a long time.

The evaluation method was established in 1975|