🔗 Share this article

In her eighth month of pregnancy and suffering, the expectant mother went to the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and became sick.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had used fentanyl before coming to the ER and had only a brief window to get treated before she needed to go home to relapse. She thought she still had four weeks left to plan her recovery and have this baby.

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

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

Five days later, on the 12th of November, Stephanie had a daughter weighing a small weight – born before term, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been administered four hours before delivery.

She felt ill. Ill-equipped for parenting. Unworthy.

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she failed. She felt hopeless, berating herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her supplier declined to supply to her when she became visibly pregnant.

“However, I failed,” she said. “I needed help.”

The widespread belief that her love for her baby would make her quit only led to deeper self-loathing and self-harm, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was connected to tubes and leads, so small she thought she would break her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.

Nurses and doctors told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, results get better, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to collect her.

She departed the institution still in recovery, scared and uncertain about what would follow.

---

At the care center, Stephanie still was concerned that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could arrive and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about getting by. Substances came first; reliance came last.

Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to hurt her. She did not know how to love herself, not to mention anyone else.

Every day, staff from Maddie’s Place drove her to a clinic for methadone, administered in pill form. Slowly, she was starting to get clean.

She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all typical problems for babies born with NAS.

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

During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is dressed in casual attire, a gray knit hat with a bobble on her head, seated on the ground with the exit nearby. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her knee for the young ones to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the moms: “Why are there no men?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if possible.

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

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could parent.”

---

Tools for treating babies with exposure have been used for a long time.

The evaluation method was created in 1975|