She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, Stephanie Rosell went to the hospital emergency room after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before coming to the ER and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to plan her recovery and have this baby.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was severe, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.
Five days later, on 12 November 2022, Stephanie delivered a infant weighing a small weight – early, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her epidural had failed, her last dose of fentanyl had been given shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Undeserving.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she relapsed. She felt hopeless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I needed help.”
The common assumption that her love for her baby would make her recover only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.
The infant was moved to the special care nursery. When Stephanie eventually visited her, she was connected to monitors, so little she thought she would break her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.
Nurses and doctors told her about a care center, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.
In many parts of America, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals 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, custody cases decrease and overall savings increase.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to pick her up.
She left the medical center still in withdrawal, fearful and unsure about what would happen next.
At Maddie’s Place, Stephanie still was concerned 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 arrive and remove her child.
For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Drugs came first; trust came last.
Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to value herself, much less anyone else.
Every day, staff from the facility took her to a clinic for methadone, given as medication. Over time, she was starting to get clean.
She devoted all her time when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I could do this. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a recovery coach, visited with her own family in tow to deliver baked goods. They all gathered around 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. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing black pants and a hoodie, a gray knit hat with a pompom on her head, seated on the ground with the door behind her. She is thin. Her head is tilted forward so you miss her features. She is holding Izzie up on her knee for the children to see and they are gathered around, admiring and touching to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if they could.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I could be a mom.”
Approaches for managing drug-exposed newborns have been used for a long time.
The Finnegan NAS scale was established in 1975|
