Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after an infection began spreading up her legs. Without a job or home, separated from loved ones, she lived in a shed she had assembled in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and became sick.
Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”
She had consumed opioids before coming to the ER and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to find a way to become sober 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 medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, 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 commonly used in addiction recovery.
After five days, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – early, small but alive.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given a few hours prior to birth.
She felt unwell. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, berating herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her dealer would not provide to her when she became clearly expecting.
“But I couldn’t,” she said. “I had to seek support.”
The common assumption that her love for her baby would make her recover only led to increased guilt and negative self-talk, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.
The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to monitors, so little she thought she would harm her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
After two days she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.
Nurses and doctors told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.
In many parts of America, where a baby is identified with newborn addiction symptoms frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like the care home is proving a simple point: when families are kept intact, outcomes improve, custody cases decrease and overall savings increase.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to collect her.
She stepped out of the hospital still in withdrawal, anxious and doubtful about what would happen next.
At Maddie’s Place, Stephanie still feared that child services would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any point, 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 survival. Substances came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She was unable to love herself, much less anyone else.
Each day, staff from the center transported her to a recovery program, given as medication. Gradually, she was embracing sobriety.
She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I was capable. I could parent.
On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. A support specialist, a recovery coach, stopped by with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in admiration of the little newborn 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 has an image of the moment. She is wearing casual attire, a beanie with a pompom on her head, seated on the ground with the entryway at her back. She is slender. Her face is downcast 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.
Jacob, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if they could.
“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could parent.”
Approaches for managing babies with exposure have existed for decades.
The assessment tool was established in 1975|
