She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and threw up.
Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”
She had consumed opioids before arriving at the hospital and had just enough time to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and give birth.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie had a baby girl weighing just over four pounds – born before term, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been administered shortly before she gave birth.
She felt ill. Unprepared to be a mother. Not fit.
Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she relapsed. She felt without value, criticizing herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her source refused to sell to her when she became visibly pregnant.
“But I couldn’t,” she said. “I required assistance.”
The common assumption that her affection for her child would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would break her. Embracing her at last, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where women and their babies are treated together, not apart.
In many parts of America, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to bring her to the facility.
She stepped out of the hospital still in withdrawal, fearful and unsure about what would come next.
At the facility, Stephanie still was concerned 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 moment, someone could enter and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about enduring. Substances came first; reliance came last.
Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to cause pain. She did not know how to care for herself, not to mention anyone else.
Each day, staff from Maddie’s Place took her to a recovery program, provided orally. Slowly, she was beginning recovery.
She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all common issues for babies exposed to substances.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. A support specialist, a mentor, stopped by with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She has an image of the moment. She is clad in casual attire, a beanie with a bobble on her head, seated on the ground with the door behind her. She is slender. Her face is downcast so you cannot see her face. She is holding Izzie up on her lap for the other kids to see and they are crowding near, admiring and touching to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The women attempted to clarify 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. They will know they are valued.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I would become a mother.”
Methods to address infants affected by substances have existed for decades.
The Finnegan NAS scale was created in 1975|
