Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, Stephanie Rosell went to the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and threw up.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”
She had used fentanyl before arriving at the hospital and had just enough time to get treated before she had to return to relapse. She thought she still had four weeks left to plan her recovery and have this baby.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was critical, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.
After five days, on 12 November 2022, Stephanie delivered a daughter weighing just over four pounds – born before term, tiny yet healthy.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her last dose 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 multiple times while expecting, and felt terrible each time she was unsuccessful. She felt without value, blaming herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier declined to supply to her when she became clearly expecting.
“But I couldn’t,” she said. “I required assistance.”
The pervasive expectation that her love for her baby would make her recover only led to deeper self-loathing and negative self-talk, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so small she thought she would break her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.
In much of the US, where a baby is identified with infant withdrawal condition regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, foster placements fall and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to collect her.
She left the medical center still in recovery, anxious and doubtful about what would follow.
At the facility, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could walk in and separate them.
For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Substances came first; trust came last.
Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to cause pain. She was unable to value herself, let alone anyone else.
Daily, staff from Maddie’s Place drove her to a clinic for methadone, given as medication. Gradually, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all typical problems for babies exposed to substances.
Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.
During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. A support specialist, a mentor, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, sitting on the wooden floor with the door behind her. She is lean. Her posture is humble so you cannot see her face. She is holding Izzie up on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.
One child, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I would become a mother.”
Methods to address infants affected by substances have existed for decades.
The Finnegan NAS scale was created in 1975|
