She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Saved Them Both.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at 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 built in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. The onset of withdrawal began. She slumped forward and vomited.
Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”
She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to plan her recovery and give birth.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.
After five days, on 12 November 2022, Stephanie gave birth to a daughter weighing a small weight – early, small but alive.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been given a few hours prior to birth.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she failed. She felt worthless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her dealer 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 trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to medical equipment, so tiny she thought she would harm her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.
Nurses and doctors told her about a care center, 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 infant withdrawal condition regularly, infants are still whisked to NICUs 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, outcomes improve, custody cases decrease and overall savings increase.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to collect her.
She left the medical center still in detox, fearful and unsure about what would happen next.
At the facility, Stephanie still feared that child services would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any time, someone could enter and take her baby away.
For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Addiction came first; faith came last.
Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to hurt her. She did not know how to love herself, let alone anyone else.
Every day, staff from Maddie’s Place transported her to a recovery program, given as medication. Gradually, 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 daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.
During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a cap with a bobble on her head, resting on the floor with the entryway at her back. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her lap for the young ones to see and they are standing close, admiring and touching to the baby.
One child, eight, asked the mothers: “Why are there no men?” The parents responded that the men were occupied, handling responsibilities, that they would be there if possible.
“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could be a mom.”
Tools for treating babies with exposure have been available for years.
The Finnegan NAS scale was developed in 1975|
