Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the ER after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a companion's property. She was also hooked on fentanyl.
As doctors treated her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and get high.”
She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to plan her recovery and have this baby.
The medical professional intervened. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in rehabilitation.
After five days, on 12 November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – early, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been provided shortly before she gave birth.
She felt sick. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she relapsed. She felt without value, criticizing herself for not being able to do the impossible. An OBGYN 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 needed help.”
The widespread belief that her bond with her newborn would make her quit only led to increased guilt and negative self-talk, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the NICU. When Stephanie at last met her, she was hooked up to monitors, so tiny she thought she would harm her. Cradling her initially, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to give her child the name Izzie, after the attendant who showed compassion to her.
Hospital staff told her about a care center, 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 found to have neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when mothers and babies stay together, results get better, foster placements fall and long-term costs decline.
It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.
She departed the institution still in detox, scared and uncertain about what would come next.
At the facility, Stephanie still was concerned that child services would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could enter and remove her child.
For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about getting by. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to hurt her. She was unable to value herself, let alone anyone else.
Every day, staff from Maddie’s Place transported her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an specialist – all frequent conditions for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a pompom on her head, sitting on the wooden floor with the door behind her. She is lean. Her face is downcast so you do not see her expression. She is lifting the baby on her knee for the children to see and they are crowding near, fawning and reaching out to the baby.
A young boy, eight, asked the moms: “Why are there no men?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there if possible.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I would become a mother.”
Methods to address drug-exposed newborns have been used for a long time.
The assessment tool was developed in 1975|
