Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, 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 built in a acquaintance's garden. She was also dependent on fentanyl.
As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and became sick.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids before seeking medical help and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and have this baby.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the doctors would not let her go: the infection in her legs was serious, but doctors had discovered she also had an leakage of amniotic fluid. 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 measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
A short time later, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – born before term, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her pain relief did not work, her last dose of fentanyl had been provided a few hours prior to birth.
She felt sick. Not ready for motherhood. Unworthy.
Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her source refused to sell to her when she became clearly expecting.
“But I couldn’t,” she said. “I had to seek support.”
The widespread belief that her love for her baby would make her recover only led to increased guilt and self-abuse, a trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.
The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to medical equipment, so tiny she thought she would break her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.
In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a developing system of centers like this facility is proving a simple point: when mothers and babies stay together, results get better, fewer children enter care and future expenses reduce.
It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She stepped out of the hospital still in detox, anxious and doubtful about what would come next.
At the facility, 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 walk in and take her baby away.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about getting by. Drugs came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She was unable to care for herself, much less anyone else.
Daily, staff from the facility transported her to a recovery program, administered in pill form. Slowly, she was starting to get clean.
She spent every minute beyond therapy 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 increased sensitivity and required an professional – all frequent conditions for babies exposed to substances.
When a child recognizes these infants need affection, then I could do this. I could parent.
On a day prior to the holiday, Stephanie was in the common room, where those still using can come for supervised visits with their babies. An advocate, a recovery coach, visited with her own children in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She has an image of the moment. She is wearing black pants and a hoodie, a gray knit hat with a decoration on her head, sitting on the wooden floor with the door behind her. She is thin. Her head is tilted forward so you do not see her expression. She is lifting the baby on her lap for the other kids to see and they are crowding near, fawning and reaching out to the baby.
One child, eight, asked the parents: “Why are there no men?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if possible.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I would become a mother.”
Approaches for managing infants affected by substances have existed for decades.
The evaluation method was developed in 1975|
