Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had built in a companion's property. She was also dependent on fentanyl.
As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to figure out how to get clean and have this baby.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
After five days, on a day in November 2022, Stephanie had a baby girl weighing just over four pounds – early, tiny yet healthy.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been administered a few hours prior to birth.
She felt unwell. Not ready for motherhood. Unworthy.
Stephanie had tried to get clean several times during pregnancy, and felt awful each time she was unsuccessful. She felt worthless, criticizing herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her dealer declined to supply to her when she became clearly expecting.
“However, I failed,” she said. “I needed help.”
The pervasive expectation that her bond with her newborn would make her quit only led to deeper self-loathing and negative self-talk, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the NICU. When Stephanie finally saw her her, she was hooked up to medical equipment, so little 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 still wasn’t sure she wanted to be her mother.
Following a brief period she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.
Hospital staff told her about a care center, a new kind of care center where women and their babies are treated together, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, custody cases decrease and long-term costs decline.
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, care providers came to pick her up.
She stepped out of the hospital still in withdrawal, anxious and doubtful about what would happen next.
At the care center, Stephanie still feared that child services would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could enter and remove her child.
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 survival. Substances came first; reliance came last.
Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to cause pain. She was unable to value herself, not to mention anyone else.
Daily, staff from Maddie’s Place drove her to a clinic for methadone, administered in pill form. Gradually, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all common issues for babies affected by withdrawal.
When a child recognizes these infants need affection, then I could do this. I could parent.
During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, came over with her own five kids in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She has an image of the moment. She is clad in black pants and a hoodie, a beanie with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her posture is humble so you cannot see her face. She is presenting her daughter on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The parents responded that the men were occupied, called away to other tasks, that they would be there if possible.
“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could be a mom.”
Tools for treating babies with exposure have existed for decades.
The assessment tool was developed in 1975|
