Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, Stephanie Rosell visited the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also hooked on fentanyl.
As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”
She had consumed opioids 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 four weeks left to figure out how to get clean and have this baby.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs 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 not survive.
She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, 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 a day in November 2022, Stephanie gave birth to a daughter weighing just over four pounds – born before term, tiny yet healthy.
When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been administered four hours before delivery.
She felt ill. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The widespread belief that her bond with her newborn would make her recover only led to increased guilt and self-abuse, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was hooked up to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
After two days she decided to name her baby Izzie, after the professional who provided support to her.
Nurses and doctors told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In numerous states, where a baby is identified with newborn addiction symptoms regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like the care home is showing an important truth: when mothers and babies stay together, recovery succeeds, custody cases decrease and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to bring her to the facility.
She left the medical center still in recovery, fearful and unsure about what would come next.
At the care center, Stephanie still feared that CPS would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could enter and take her baby away.
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. Addiction 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 was unable to value herself, not to mention anyone else.
Every day, staff from Maddie’s Place transported her to a clinic for methadone, given as medication. Over time, she was embracing sobriety.
She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies affected by withdrawal.
When a child recognizes these infants need affection, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. An advocate, a recovery coach, came over with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She has an image of the moment. She is wearing casual attire, a cap with a decoration on her head, sitting on the wooden floor with the exit nearby. She is thin. Her head is tilted forward so you do not see her expression. She is lifting the baby on her knee for the young ones to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the dads were busy, handling responsibilities, that they would be there if they could.
“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could be a mom.”
Tools for treating babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
