Angela Holmes, 37, with her fifth child, Jaheem Davis, 17 months old. Holmes first came to the Center for Comprehensive Health Practice (CCHP) in East Harlem in 2003, eight months pregnant and in desperate need of treatment for her heroin addiction. “I knew time was running out,” Holmes said. “Honestly this was the only program in New York that would take me pregnant.” Pregnant women addicted to opioids – whether illicit drugs like heroin or prescribed painkillers like OxyContin – face a dearth of treatment options, say doctors and patients alike.

Robin Beard, right, a Senior Counselor at CCHP, helps lead the Young Mothers group, which provides educational and other support for mothers and pregnant women on methadone. “When you have an addiction, so many things come into play,” says CCHP’s Medical Director Mariely Fernandez. “So many social factors, so many economic factors… you just can’t treat it in a singular, silo kind of approach.”

Nicole Watson, 22, and four months pregnant, adds water to her dose of methadone at CCHP. Methadone maintenance treatment is the widely recommended approach for pregnant women with opioid addiction and is safer for a fetus than an abstinence-only approach, experts say. CCHP’s Pregnant Addicts and Addicted Mothers (PAAM) program, which began in 1975, combines methadone treatment with access to counselors, therapists, and primary-care doctors.

Zasha Lugo, 25, listens during the Young Mothers group. Babies born to mothers on methadone can show symptoms of drug withdrawal, as was the case with Lugo’s two-month-old daughter, Ovenia. Such babies are routinely treated in the hospital. “I think the scary thing for the moms,” says Medical Director Fernandez**,** is that often “they really don’t know what to expect” when their babies are born. Ovenia is getting better now, says Lugo: “She’s beautiful. She has all her fingers and her toes. Her nose is where it’s supposed to be.”

Angela Holmes, 37, center, a recovering heroin addict who has been clean since 2007, with her daughter, Armani Davis, 6, left, and son Jermaine Davis, 12, at the Early Childhood Development Center at CCHP. Both children were born when Holmes was in methadone treatment. “I’m really trying to fix my life,” says Holmes, who adds that her drug use started at age 14 when she was given PCP by her stepfather. Holmes, who plans on returning to school, says she wants to lead her children by example. “My life story – which is negative to them – I don’t want to keep using that. I want to show them more than I can tell them.”

Nicole Watson, 22, part of CCHP’s Pregnant Addicts and Addicted Mothers program, talks with her counselor, Joanne Hernandez. Watson, who first started abusing prescription painkillers like Roxicodone and Percocet at age 14, began shooting heroin at 15. A deep downward spiral ended in a miscarriage, says Watson, after which she began methadone treatment. “Methadone is the only thing that’s been able to keep me clean and stable,” says Watson, now four months pregnant.

Nicole Watson drinks her methadone dose at CCHP. “I have guilt that people don’t really know about. They can’t look into my brain and know the guilt that I face for being on methadone.” But, Watson says, “I wish the world wasn’t so judgmental…I see babies who are born on methadone who’ve been very sick at birth, and you would never know they were on methadone. Because they’re so healthy, they’re such healthy babies now.”

The Young Mothers group for pregnant women and mothers on methadone meets at CCHP, as the daughter of one mother plays on the floor. Born with withdrawal symptoms, the infant was treated at the hospital and is now healthy. “Stigmas still exist” for pregnant women on methadone, says Liliana Villar-Durrani, Director of PAAM. And because of that, she says, women may be afraid to seek treatment or become anxious leading up to the birth of their child.

“Being around the mothers helps me,” says Nicole Watson, right, with Zasha Lugo, 25, center. “Without that, I don’t know if I’d be mentally prepared.” Watson says she feels the stigma surrounding addicted mothers. “That’s what society has done to us, it has labeled us, and it’s a shame.” But “I can’t stop what I’ve already done. All I can do is fix it, to the best of my ability.” And “if you strip me of my addiction, I’m still a woman. I’m still a young mother. I still love my child.”

Nicole Watson, right, jokes with her friend Nelson Colon, a fellow patient, outside CCHP. “What’s important to me is that I stabilize my life, I have a life for my baby,” says Watson. “She may not have everything that she wants, but she’ll damn well have everything that she needs.”

This image has an empty alt attribute; its file name is 1437492746798_SW_Retro_Addiction_011-1600px.jpg

“I have a lot to look forward to, but I also have a lot of – how you say – trials and tribulations in my way,” says Nicole Watson, with the daughter of a fellow patient and close friend. “As soon as I got pregnant I saw a black hole. I didn’t see a future for myself. Now I see a beautiful future…I see myself growing a lot, and I see myself moving forward from this hole and this rut that I’ve been stuck in.”