Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”
She had taken the drug before seeking medical help and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to plan her recovery 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 condition in her limbs was severe, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.
She encouraged 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 placed on methadone, a medication that eases withdrawal and is commonly used in addiction recovery.
Five days later, on the 12th of November, Stephanie had a infant weighing 4lb 8oz – early, small but alive.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been given shortly before she gave birth.
She felt sick. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery several times during pregnancy, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her dealer would not provide to her when she became visibly pregnant.
“But I couldn’t,” she said. “I needed help.”
The pervasive expectation that her bond with her newborn would make her quit only led to greater shame and self-harm, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to monitors, so tiny she thought she would hurt her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.
In much of the US, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a developing system of centers like this facility is proving a simple point: when parents and infants remain united, recovery succeeds, fewer children enter care and future expenses reduce.
It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, two staff members came to pick her up.
She left the medical center still in recovery, fearful and unsure about what would follow.
At the care center, Stephanie still was concerned that child services would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any time, someone could arrive and take her baby away.
For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about enduring. Drugs came first; faith came last.
Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to let her down. She was unable to love herself, not to mention anyone else.
Every day, staff from the center drove her to a clinic for methadone, provided orally. Over time, she was starting to get clean.
She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I could do this. I would become a mother.
On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. An advocate, a mentor, visited with her own five kids in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a cap with a decoration on her head, sitting on the wooden floor with the exit nearby. She is lean. Her posture is humble so you miss her features. She is presenting her daughter on her lap for the children to see and they are crowding near, admiring and touching to the baby.
A young boy, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if possible.
“In the future,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could parent.”
Tools for treating drug-exposed newborns have existed for decades.
The assessment tool was developed in 1975|