🔗 Share this article

Eight months pregnant and in severe pain, the expectant mother went to the hospital emergency room after her infection worsened up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also dependent on fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had consumed opioids 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 find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

After five days, on the 12th of November, Stephanie delivered a infant weighing 4lb 8oz – early, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.

She felt unwell. Ill-equipped for parenting. Not fit.

Stephanie had sought recovery repeatedly before birth, and felt awful each time she failed. She felt worthless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her source would not provide to her when she became clearly expecting.

“Yet I was unable,” she said. “I needed help.”

The pervasive expectation that her love for her baby would make her quit only led to increased guilt and self-harm, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to tubes and leads, so little she thought she would harm her. Embracing her at last, she felt nothing. “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 attendant who showed compassion to her.

Medical personnel told her about a specialized facility, a unique recovery environment where women and their babies are treated together, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, results get better, foster placements fall and future expenses reduce.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.

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

---

At the care center, Stephanie still was concerned that authorities would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could arrive 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 didn’t have a lot of trust at that point.”

Homelessness, she said, was about getting by. Drugs came first; reliance came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She lacked the ability to care for herself, much less anyone else.

Daily, staff from the facility took her to a treatment center, provided orally. Over time, she was embracing sobriety.

She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies exposed to substances.

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

On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. An advocate, a mentor, stopped by with her own children in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She keeps a photo of the moment. She is wearing casual attire, a gray knit hat with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her face is downcast so you miss her features. She is presenting her daughter on her leg for the other kids to see and they are gathered around, showing interest to the baby.

Jacob, eight, asked the mothers: “Where are all the dads?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could be a mom.”

---

Approaches for managing drug-exposed newborns have existed for decades.

The evaluation method was established in 1975|