Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the hospital emergency room after her infection worsened up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and vomited.
Stephanie eventually collapsed. “I have to get out of here. 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 use once more. She thought she still had several weeks to find a way to become sober and give birth.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.
After five days, on 12 November 2022, Stephanie delivered a daughter weighing 4lb 8oz – premature, tiny yet healthy.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her pain relief did not work, her last dose of fentanyl had been administered four hours before delivery.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery repeatedly before birth, and felt horrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her supplier declined to supply to her when she became obviously with child.
“Yet I was unable,” she said. “I needed help.”
The widespread belief that her love for her baby would make her stop using only led to greater shame and self-harm, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was connected to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the nurse who had been so kind to her.
Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.
In many parts of America, where a baby is diagnosed with infant withdrawal condition frequently, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like the care home is showing an important truth: when parents and infants remain united, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, two staff members came to pick her up.
She left the medical center still in detox, anxious and doubtful about what would come next.
At the care center, Stephanie still was concerned that CPS would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could walk in and separate them.
For the beginning period, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about survival. Substances came first; faith came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She was unable to care for herself, let alone anyone else.
Each day, staff from the center drove her to a clinic for methadone, given as medication. Slowly, she was beginning recovery.
She devoted all her time outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an professional – all common issues for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own children 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 awe 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. None of those things mattered to them.”
She holds a picture of the moment. She is dressed in black pants and a hoodie, a beanie with a pompom on her head, sitting on the wooden floor with the exit nearby. She is lean. Her face is downcast so you miss her features. She is holding Izzie up on her leg for the other kids to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if they could.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”
Methods to address babies with exposure have been available for years.
The evaluation method was developed in 1975|
