Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
In her eighth month of pregnancy and suffering, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also hooked on fentanyl.
As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”
She had taken the drug before coming to the ER and had just enough time to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to find a way to become sober and deliver her child.
The medical professional intervened. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie had a infant weighing a small weight – early, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been given a few hours prior to birth.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean several times during pregnancy, and felt awful each time she was unsuccessful. She felt hopeless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her quit only led to deeper self-loathing and self-harm, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.
The baby was taken to the special care nursery. When Stephanie at last met her, she was connected to monitors, so small she thought she would break her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to call her daughter the same as her nurse, after the nurse who had been so kind to her.
Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, results get better, custody cases decrease and future expenses reduce.
It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to pick her up.
She left the medical center still in recovery, anxious and doubtful about what would come next.
At the care center, Stephanie still feared that authorities would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could arrive and separate them.
For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about survival. Drugs came first; reliance came last.
Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to hurt her. She was unable to care for herself, much less anyone else.
Daily, staff from the facility transported her to a treatment center, administered in pill form. Slowly, she was beginning recovery.
She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an professional – all frequent conditions for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. A support specialist, a recovery coach, came over with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She keeps a photo of the moment. She is clad in casual attire, a cap with a decoration on her head, seated on the ground with the exit nearby. She is thin. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her lap for the young ones to see and they are gathered around, showing interest to the baby.
A young boy, eight, asked the moms: “What about the fathers?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I would become a mother.”
Tools for treating drug-exposed newborns have existed for decades.
The assessment tool was created in 1975|
