🔗 Share this article

In her eighth month of pregnancy and suffering, a woman named Stephanie visited the ER after her infection worsened up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had assembled in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had several weeks to figure out how to get clean and give birth.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.

Five days later, on the 12th of November, Stephanie gave birth to a baby girl weighing a small weight – early, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been provided shortly before she gave birth.

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

Stephanie had sought recovery multiple times while expecting, and felt terrible each time she failed. She felt without value, criticizing herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her dealer declined to supply to her when she became visibly pregnant.

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

The widespread belief that her affection for her child would make her quit only led to deeper self-loathing and negative self-talk, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was attached to tubes and leads, so small she thought she would harm her. Cradling her initially, she felt nothing. “I gazed upon 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 call her daughter Izzie, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where women and their babies are cared for jointly, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, recovery succeeds, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She stepped out of the hospital still in detox, scared and uncertain about what would come next.

---

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

For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about enduring. Addiction came first; trust came last.

Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She was unable to value herself, let alone anyone else.

Every day, staff from the facility drove her to a clinic for methadone, given as medication. Gradually, she was beginning recovery.

She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all typical problems for babies affected by withdrawal.

Seeing that even a young person understands the need for care, 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 monitored interactions with their babies. A support specialist, a mentor, visited with her own children in tow to drop off cookies. They all crowded near 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 had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She keeps a photo of the moment. She is clad in black pants and a hoodie, a cap with a bobble on her head, resting on the floor with the entryway at her back. She is thin. Her face is downcast so you do not see her expression. She is holding Izzie up on her lap for the other kids to see and they are standing close, showing interest to the baby.

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

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could parent.”

---

Approaches for managing infants affected by substances have existed for decades.

The evaluation method was developed in 1975|