🔗 Share this article

Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and threw up.

Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”

She had used fentanyl before coming to the ER and had only a brief window to get treated before she had to return to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, 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 face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

After five days, on the 12th of November, Stephanie delivered a daughter weighing 4lb 8oz – premature, small but alive.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her final administration of fentanyl had been given a few hours prior to birth.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she failed. She felt hopeless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer would not provide 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 recover only led to increased guilt and self-harm, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.

The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to medical equipment, so little she thought she would hurt her. Holding her for the first time, she felt detached. “I gazed upon 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 call her daughter the same as her nurse, after the professional who provided support to her.

Nurses and doctors told her about a care center, a new kind of care center where women and their babies are treated together, not apart.

In many parts of America, where a baby is identified with newborn addiction symptoms frequently, infants are still quickly moved to hospitals 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 mothers and babies stay together, recovery succeeds, fewer children enter care and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to pick her up.

She departed the institution still in recovery, anxious and doubtful about what would come next.

---

At the facility, Stephanie still was concerned that authorities would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any time, someone could enter and remove her child.

For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about getting by. Drugs came first; faith came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She lacked the ability to love herself, much less anyone else.

Daily, staff from the facility transported her to a treatment center, given as medication. Gradually, she was embracing sobriety.

She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all common issues for babies affected by withdrawal.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a pompom on her head, sitting on the wooden floor with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is presenting her daughter on her lap for the young ones to see and they are standing close, admiring and touching to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if possible.

“When I have kids,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could parent.”

---

Approaches for managing drug-exposed newborns have been used for a long time.

The Finnegan NAS scale was established in 1975|