Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
In her eighth month of pregnancy and suffering, Stephanie Rosell visited the medical facility after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also hooked on fentanyl.
As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”
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 several weeks to find a way to become sober and deliver her child.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the leg infection was serious, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.
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 treatment that reduces symptoms and is often prescribed in addiction recovery.
A short time later, on 12 November 2022, Stephanie had a baby girl weighing 4lb 8oz – premature, little but surviving.
When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her source would not provide to her when she became visibly pregnant.
“But I couldn’t,” she said. “I required assistance.”
The widespread belief that her affection for her child would make her recover only led to greater shame and self-abuse, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.
The baby was taken to the NICU. When Stephanie at last met her, she was hooked up to medical equipment, so little she thought she would break her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
After two days she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to pick her up.
She departed the institution still in recovery, anxious and doubtful about what would happen next.
At the care center, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could walk in and take her baby away.
For the first two weeks, 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.”
Survival outdoors, she said, was about getting by. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to hurt her. She did not know how to love herself, let alone anyone else.
Every day, staff from the facility took her to a clinic for methadone, given as medication. Slowly, 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 infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. An advocate, a mentor, stopped by with her own family in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in wonder 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 has an image of the moment. She is clad in black pants and a hoodie, a gray knit hat with a decoration on her head, seated on the ground with the door behind her. She is slender. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her leg for the other kids to see and they are gathered around, fawning and reaching out to the baby.
Jacob, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could be a mom.”
Tools for treating drug-exposed newborns have been available for years.
The assessment tool was developed in 1975|
