She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the ER after her infection worsened up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a companion's property. She was also addicted to fentanyl.
As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and threw up.
Stephanie finally broke down. “Listen, I gotta go. 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 get high again. She thought she still had a month remaining to figure out how to get clean and have this baby.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was severe, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie delivered a daughter weighing a small weight – born before term, small but alive.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been administered shortly before she gave birth.
She felt ill. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she was unsuccessful. She felt worthless, blaming herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her dealer would not provide to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
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 impetus for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to tubes and leads, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to name her baby Izzie, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, recovery succeeds, fewer children enter care and long-term costs decline.
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 bring her to the facility.
She left the medical center still in withdrawal, fearful and unsure about what would come next.
At Maddie’s Place, Stephanie still feared that authorities would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could enter and take her baby away.
For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about enduring. Drugs came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to cause pain. She was unable to love herself, much less anyone else.
Each day, staff from the facility took her to a recovery program, given as medication. Slowly, she was embracing sobriety.
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 girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie was in the common room, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own children in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She holds a picture of the moment. She is clad in casual attire, a cap with a decoration on her head, resting on the floor with the entryway at her back. She is slender. Her face is downcast so you do not see her expression. She is presenting her daughter on her lap for the young ones to see and they are standing close, showing interest to the baby.
One child, eight, asked the mothers: “Where are all the dads?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”
Tools for treating babies with exposure have existed for decades.
The evaluation method was developed in 1975|
