Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
In her eighth month of pregnancy and suffering, Stephanie Rosell visited the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had built in a friend’s yard. She was also dependent on fentanyl.
As doctors treated her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and became sick.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”
She had taken the drug before arriving at the hospital and had only a brief window to get treated before she needed to go home to use once more. She thought she still had several weeks to plan her recovery and deliver her child.
The medical professional intervened. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was critical, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie delivered a daughter weighing 4lb 8oz – premature, small but alive.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her epidural had failed, her final administration of fentanyl had been provided four hours before delivery.
She felt ill. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer declined to supply to her when she became obviously with child.
“But I couldn’t,” she said. “I needed help.”
The common assumption that her love for her baby would make her recover only led to increased guilt and self-harm, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.
The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to medical equipment, so little she thought she would hurt her. Cradling her initially, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.
In numerous states, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, care providers came to bring her to the facility.
She departed the institution still in withdrawal, fearful and unsure about what would follow.
At the care center, Stephanie still was concerned that authorities would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could walk in and separate them.
For the initial fortnight, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about enduring. Substances came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to let her down. She was unable to care for herself, not to mention anyone else.
Daily, staff from the facility took her to a clinic for methadone, administered in pill form. Gradually, 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 infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. 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 could do this. I would become a mother.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She has an image of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, sitting on the wooden floor with the door behind her. She is thin. Her face is downcast so you do not see her expression. She is holding Izzie up on her lap for the young ones to see and they are standing close, showing interest to the baby.
A young boy, eight, asked the mothers: “Why are there no men?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if they could.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I would become a mother.”
Methods to address drug-exposed newborns have been available for years.
The evaluation method was established in 1975|
