She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, Stephanie Rosell visited the ER after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had assembled in a acquaintance's garden. She was also hooked on fentanyl.
As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”
She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had several weeks to plan her recovery and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.
Five days later, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – early, tiny yet healthy.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.
She felt sick. Not ready for motherhood. Not fit.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her dealer refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I needed help.”
The common assumption that her affection for her child would make her stop using only led to deeper self-loathing and negative self-talk, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would hurt her. Holding her for the first time, she felt nothing. “I gazed upon 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 name her baby after her caregiver, after the professional who provided support to her.
Nurses and doctors told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a developing system of centers like this facility is proving a simple point: when mothers and babies stay together, outcomes improve, foster placements fall and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to collect her.
She departed the institution still in recovery, anxious and doubtful about what would come next.
At the care center, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could walk in and separate them.
For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about survival. Drugs came first; reliance came last.
Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to cause pain. She lacked the ability to value herself, much less anyone else.
Each day, staff from the center drove her to a clinic for methadone, administered in pill form. Over time, she was starting to get clean.
She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. A support specialist, a mentor, stopped by with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the tiny infant 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 clad in casual attire, a beanie with a pompom on her head, sitting on the wooden floor with the exit nearby. She is thin. Her face is downcast so you do not see her expression. She is lifting the baby on her lap for the other kids to see and they are gathered around, showing interest to the baby.
A young boy, eight, asked the moms: “What about the fathers?” The moms tried to explain 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. I will teach them about love.”
Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could be a mom.”
Tools for treating drug-exposed newborns have been available for years.
The Finnegan NAS scale was developed in 1975|
