Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the medical facility after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also hooked on fentanyl.
As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.
Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”
She had taken the drug before coming to the ER and had just enough time to get treated before she needed to go home to get high again. She thought she still had a month remaining to plan her recovery and have this baby.
The attending nurse disagreed. 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 serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
A short time later, on a day in November 2022, Stephanie had a daughter weighing just over four pounds – born before term, little but surviving.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been administered shortly before she gave birth.
She felt sick. Unprepared to be a mother. Unworthy.
Stephanie had sought recovery repeatedly before birth, and felt horrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her supplier refused to sell to her when she became obviously with child.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her stop using only led to deeper self-loathing and self-abuse, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.
The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to tubes and leads, so little she thought she would harm her. Embracing her at last, she felt detached. “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 name her baby after her caregiver, after the professional who provided support to her.
Hospital staff told her about a specialized facility, a innovative treatment home where women and their babies are supported as a unit, not apart.
In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is proving a simple point: when families are kept intact, results get better, foster placements fall and overall savings increase.
It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to pick her up.
She stepped out of the hospital still in detox, anxious and doubtful about what would come next.
At Maddie’s Place, Stephanie still worried that authorities would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could enter and take her baby away.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about survival. Drugs came first; faith came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She lacked the ability to value herself, not to mention anyone else.
Every day, staff from the facility drove her to a treatment center, given as medication. Slowly, she was starting to get clean.
She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an professional – all typical problems for babies born with NAS.
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 individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, seated on the ground with the door behind her. She is thin. Her posture is humble so you cannot see her face. She is lifting the baby on her leg for the other kids to see and they are standing close, showing interest to the baby.
One child, eight, asked the moms: “What about the fathers?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could be a mom.”
Methods to address babies with exposure have been available for years.
The assessment tool was developed in 1975|
