🔗 Share this article

Pregnant and experiencing intense discomfort, the expectant mother went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also dependent on fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and became sick.

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

She had used fentanyl 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 several weeks to find a way to become sober and give birth.

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 doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.

Five days later, on 12 November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – early, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been administered four hours before delivery.

She felt unwell. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she was unsuccessful. She felt worthless, blaming herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her supplier refused to sell to her when she became visibly pregnant.

“However, I failed,” she said. “I required assistance.”

The common assumption that her love for her baby would make her stop using only led to deeper self-loathing and negative self-talk, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The infant was moved to the NICU. When Stephanie eventually visited her, she was attached to medical equipment, so tiny 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.

Two days later she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about Maddie’s Place, a innovative treatment home where women and their babies are cared for jointly, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence 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 stepped out of the hospital still in recovery, anxious and doubtful about what would happen next.

---

At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could walk in and separate them.

For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”

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

Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to let her down. She lacked the ability to care for herself, much less anyone else.

Daily, staff from the center drove her to a recovery program, administered in pill form. Slowly, she was starting to get clean.

She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.

One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is clad in black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is slender. Her face is downcast so you do not see her expression. She is lifting the baby 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: “Where are all the dads?” The parents responded that the dads were busy, called away to other tasks, that they would be there if possible.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.”

---

Methods to address babies with exposure have been available for years.

The Finnegan NAS scale was established in 1975|