🔗 Share this article

In her eighth month of pregnancy and suffering, a woman named Stephanie 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 lived in a shed she had constructed in a friend’s yard. She was also dependent on fentanyl.

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

Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had several weeks to plan her recovery and give birth.

The nurse had other ideas. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.

She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.

A short time later, on a day in November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – born before term, small but alive.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.

She felt ill. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her supplier would not provide to her when she became obviously with child.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her affection for her child would make her quit only led to deeper self-loathing and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would break her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is identified with infant withdrawal condition frequently, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, recovery succeeds, fewer children enter care and overall savings increase.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to pick her up.

She departed the institution still in detox, fearful and unsure about what would follow.

---

At the care center, Stephanie still feared that authorities would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could enter and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about survival. Addiction came first; reliance came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to value herself, let alone anyone else.

Each day, staff from the facility transported her to a treatment center, given as medication. Over time, she was embracing sobriety.

She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an specialist – all frequent conditions for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. An advocate, a peer support specialist, came over with her own five kids in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a pompom on her head, sitting on the wooden floor with the door behind her. She is slender. Her face is downcast so you miss her features. She is lifting the baby on her lap for the children to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the parents: “What about the fathers?” The parents responded that the men were occupied, engaged elsewhere, that they would be there given the chance.

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

Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I would become a mother.”

---

Methods to address infants affected by substances have been available for years.

The evaluation method was developed in 1975|