Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
In her eighth month of pregnancy and suffering, Stephanie Rosell went to the ER 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 acquaintance's garden. She was also addicted to fentanyl.
As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and vomited.
Stephanie finally broke down. “I need to leave. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was serious, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
After five days, on a day in November 2022, Stephanie delivered a infant weighing just over four pounds – early, tiny yet healthy.
When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery repeatedly before birth, and felt awful each time she was unsuccessful. She felt without value, criticizing herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier refused to sell to her when she became clearly expecting.
“However, I failed,” she said. “I needed help.”
The widespread belief that her affection for her child would make her recover only led to deeper self-loathing and self-harm, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The newborn was transferred to the NICU. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would hurt her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
After two days she decided to name her baby Izzie, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, a innovative treatment home where women and their babies are treated together, not apart.
In much of the US, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is proving a simple point: when mothers and babies stay together, recovery succeeds, custody cases decrease and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to collect her.
She stepped out of the hospital still in recovery, anxious and doubtful about what would come next.
At Maddie’s Place, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could enter and separate them.
For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about enduring. Drugs came first; reliance 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 care for herself, not to mention anyone else.
Every day, staff from the facility took her to a clinic for methadone, provided orally. Gradually, she was embracing sobriety.
She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an specialist – all common issues for babies exposed to substances.
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 parents in active addiction can come for guided meetings with their babies. A support specialist, a peer support specialist, came over with her own children in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She has an image of the moment. She is clad in casual attire, a gray knit hat with a decoration on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you cannot see her face. She is presenting her daughter on her lap for the young ones to see and they are crowding near, admiring and touching to the baby.
One child, eight, asked the mothers: “What about the fathers?” The parents responded that the dads were busy, handling responsibilities, that they would be there if they could.
“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I could be a mom.”
Approaches for managing babies with exposure have been available for years.
The evaluation method was created in 1975|
