Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the ER after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had assembled in a acquaintance's garden. She was also hooked on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and became sick.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had several weeks to find a way to become sober and give birth.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.
A short time later, on 12 November 2022, Stephanie delivered a baby girl weighing a small weight – early, small but alive.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her previous intake of fentanyl had been given four hours before delivery.
She felt sick. Not ready for motherhood. Unworthy.
Stephanie had sought recovery several times during pregnancy, and felt horrible each time she failed. She felt worthless, berating herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her dealer refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her recover only led to increased guilt and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.
The baby was taken to the NICU. When Stephanie at last met her, she was connected to tubes and leads, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to call her daughter Izzie, after the nurse who had been so kind to her.
Nurses and doctors told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are supported as a unit, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like the care home is showing an important truth: when parents and infants remain united, outcomes improve, fewer children enter care and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, two staff members came to bring her to the facility.
She departed the institution still in recovery, anxious and doubtful about what would come next.
At the care center, Stephanie still worried that child services would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could arrive and remove her child.
For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She did not know how to love herself, let alone anyone else.
Each day, staff from the facility took her to a treatment center, provided orally. Gradually, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
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 sat in the visitation area, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own children in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a cap with a decoration on her head, resting on the floor with the door behind her. She is slender. Her face is downcast so you do not see her expression. She is presenting her daughter on her lap for the other kids to see and they are standing close, admiring and touching to the baby.
One child, eight, asked the moms: “Why are there no men?” 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 plan to be a great parent. They will know they are valued.”
Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I found the courage. I could be a mom.”
Methods to address babies with exposure have existed for decades.
The evaluation method was established in 1975|