🔗 Share this article

Eight months pregnant and in severe pain, a woman named Stephanie arrived at the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

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

She had used fentanyl before seeking medical help and had just enough time to get treated before she needed to go home to use once more. She thought she still had a month remaining to figure out how to get clean and deliver her child.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

Five days later, on the 12th of November, Stephanie gave birth to a infant weighing 4lb 8oz – born before term, little but surviving.

When the nurse asked if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been given shortly before she gave birth.

She felt unwell. Not ready for motherhood. Not fit.

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt without value, blaming herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her source refused to sell to her when she became clearly expecting.

“But I couldn’t,” she said. “I needed help.”

The widespread belief that her affection for her child would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the NICU. When Stephanie eventually visited her, she was attached to tubes and leads, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to name her baby Izzie, after the professional who provided support to her.

Hospital staff told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are supported as a unit, not apart.

In many parts of America, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.

It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to pick her up.

She left the medical center still in recovery, fearful and unsure about what would come next.

---

At the care center, Stephanie still feared that CPS would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could enter and remove her child.

For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to cause pain. She lacked the ability to value herself, let alone anyone else.

Every day, staff from the center took her to a treatment center, administered in pill form. Over time, she was embracing sobriety.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all common issues for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I could parent.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, visited with her own five kids in tow to bring treats. 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 were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a bobble on her head, sitting on the wooden floor with the exit nearby. She is slender. Her face is downcast so you miss her features. She is presenting her daughter on her knee for the young ones to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there if they could.

“When I have kids,” 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. “When a child recognized that newborns require care, then I could do this. I would become a mother.”

---

Tools for treating babies with exposure have existed for decades.

The evaluation method was developed in 1975|