🔗 Share this article

Pregnant and experiencing intense discomfort, the expectant mother went to the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had assembled in a companion's property. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and became sick.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she needed to go home to get high again. She thought she still had four weeks left to plan her recovery and have this baby.

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

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

After five days, on the 12th of November, Stephanie had a infant weighing a small weight – born before term, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been given shortly before she gave birth.

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

Stephanie had sought recovery multiple times while expecting, and felt horrible each time she was unsuccessful. She felt without value, blaming herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her dealer refused to sell to her when she became clearly expecting.

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

The pervasive expectation that her bond with her newborn would make her recover only led to increased guilt and negative self-talk, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was connected to medical equipment, so little she thought she would hurt her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name Izzie, after the nurse who had been so kind to her.

Hospital staff told her about Maddie’s Place, 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 identified with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like the care home is showing an important truth: when families are kept intact, results get better, custody cases decrease and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to collect her.

She departed the institution still in withdrawal, fearful and unsure about what would happen next.

---

At the facility, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any time, someone could enter and remove her child.

For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” 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 a trusted ally, but even that bond was fragile. The those close to her always found ways to let her down. She was unable to love herself, much less anyone else.

Daily, staff from Maddie’s Place drove her to a recovery program, given as medication. Gradually, she was starting to get clean.

She spent every minute outside treatment 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 pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an professional – all frequent conditions for babies exposed to substances.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, came over with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration 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 keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a cap with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her face is downcast so you cannot see her face. She is holding Izzie up on her leg for the other kids to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could parent.”

---

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

The assessment tool was developed in 1975|