🔗 Share this article

In her eighth month of pregnancy and suffering, a woman named Stephanie visited the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

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

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”

She had taken the drug before arriving at the hospital and had just enough time to get treated before she had to return to use once more. She thought she still had a month remaining to figure out how to get clean and deliver her child.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was serious, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.

Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing a small weight – born before term, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.

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

Stephanie had sought recovery multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her source declined to supply to her when she became visibly pregnant.

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

The pervasive expectation that her love for her baby would make her recover only led to increased guilt and self-harm, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.

The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to monitors, so little she thought she would hurt her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

Two days later she decided to name her baby after her caregiver, after the nurse who had been so kind to her.

Hospital staff told her about Maddie’s Place, a innovative treatment home where women and their babies are treated together, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals 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 families are kept intact, results get better, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, care providers came to pick her up.

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

---

At Maddie’s Place, Stephanie still worried that CPS would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could arrive and separate them.

For the first two weeks, 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.”

Survival outdoors, she said, was about enduring. Drugs came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She was unable to care for herself, not to mention anyone else.

Every day, staff from Maddie’s Place transported her to a clinic for methadone, given as medication. Gradually, she was starting to get clean.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all common issues for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

During a pre-holiday visit, 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 five kids in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is dressed in casual attire, a beanie with a decoration 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 knee for the children to see and they are gathered around, showing interest to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there given the chance.

“When I have kids,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could parent.”

---

Approaches for managing infants affected by substances have been available for years.

The evaluation method was established in 1975|