Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Eight months pregnant and in severe pain, Stephanie Rosell visited the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had constructed in a companion's property. 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 threw up.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”
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 get high again. She thought she still had several weeks 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 doctors would not let her go: the infection in her legs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
After five days, on 12 November 2022, Stephanie had a infant weighing a small weight – born before term, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been provided shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The common assumption that her bond with her newborn would make her quit only led to greater shame 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 persistent condition.
The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would harm her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure 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 treated together, not apart.
In much of the US, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a developing system of centers like this facility is demonstrating a key fact: when mothers and babies stay together, results get better, fewer children enter care and overall savings increase.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to pick her up.
She left the medical center still in detox, fearful and unsure about what would come next.
At the facility, Stephanie still was concerned that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could arrive and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” 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 connection was tenuous. The those close to her always found ways to cause pain. She was unable to love herself, much less anyone else.
Each day, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Gradually, she was starting to get clean.
She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I could be a mom.
On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, visited with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She holds a picture of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a decoration on her head, resting on the floor with the door behind her. She is lean. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her lap for the young ones to see and they are gathered around, fawning and reaching out to the baby.
One child, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there if possible.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I would become a mother.”
Methods to address drug-exposed newborns have existed for decades.
The assessment tool was created in 1975|
