She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.
In her eighth month of pregnancy and suffering, Stephanie Rosell visited the hospital emergency room after an infection began spreading up her legs. Without a job or home, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and became sick.
Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”
She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had a month remaining to figure out how to get clean and deliver her child.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the leg infection was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
After five days, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – early, little but surviving.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been administered shortly before she gave birth.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery repeatedly before birth, and felt terrible each time she failed. She felt hopeless, berating herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her supplier refused to sell to her when she became clearly expecting.
“Yet I was unable,” she said. “I had to seek support.”
The widespread belief that her affection for her child would make her recover only led to deeper self-loathing and negative self-talk, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.
The baby was taken to the NICU. When Stephanie eventually visited her, she was connected to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to name her baby Izzie, after the professional who provided support to her.
Hospital staff told her about a care center, a innovative treatment home where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when families are kept intact, recovery succeeds, foster placements fall 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, care providers came to bring her to the facility.
She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.
At the care center, Stephanie still feared that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could walk in and remove her child.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about enduring. Substances came first; trust came last.
Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to let her down. She did not know how to value herself, much less anyone else.
Each day, staff from the facility took her to a clinic for methadone, provided orally. Slowly, she was beginning recovery.
She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
When a child recognizes these infants need affection, then I was capable. I could be a mom.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, stopped by with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in wonder of the little newborn 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 beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her face is downcast so you miss her features. She is lifting the baby on her leg for the young ones to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the mothers: “Where are all the dads?” The parents responded that the dads were busy, 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 her companion exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.”
Approaches for managing babies with exposure have been available for years.
The evaluation method was created in 1975|
