🔗 Share this article

In her eighth month of pregnancy and suffering, 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 resided in a small structure she had assembled in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”

She had taken the drug before seeking medical help 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 find a way to become sober and have this baby.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the leg infection was critical, 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 measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.

After five days, on a day in November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – premature, tiny yet healthy.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered a few hours prior to birth.

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

Stephanie had sought recovery multiple times while expecting, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer declined to supply to her when she became obviously with child.

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

The common assumption that her love for her baby would make her recover only led to deeper self-loathing and self-abuse, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.

The infant was moved to the NICU. When Stephanie eventually visited her, she was connected to tubes and leads, so small she thought she would harm her. Embracing her at last, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to give her child the name the same as her nurse, after the professional who provided support 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 many parts of America, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like this facility is proving a simple point: when mothers and babies stay together, results get better, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, two staff members came to collect her.

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

---

At the care center, Stephanie still was concerned that child services would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could walk in and remove her child.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to let her down. She lacked the ability to love herself, not to mention anyone else.

Every day, staff from the center transported her to a clinic for methadone, provided orally. Gradually, she was beginning recovery.

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 severe digestive problems. She needed dietary support. She also had sensory challenges and required an professional – all typical problems for babies born with NAS.

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

One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. An advocate, a peer support specialist, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She has an image of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, resting on the floor with the door behind her. She is slender. Her face is downcast so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there given the chance.

“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could parent.”

---

Tools for treating drug-exposed newborns have existed for decades.

The assessment tool was developed in 1975|