Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the ER after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had constructed in a friend’s yard. She was also hooked on fentanyl.
As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and became sick.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she needed to go home to relapse. She thought she still had a month remaining to plan her recovery and give birth.
The nurse had other ideas. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.
Five days later, on the 12th of November, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, little but surviving.
When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her last dose of fentanyl had been provided four hours before delivery.
She felt sick. Ill-equipped for parenting. Unworthy.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her source refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I needed help.”
The common assumption that her affection for her child would make her stop using only led to greater shame and self-harm, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would break her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a limited but expanding group of centers like the care home 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 period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to pick her up.
She left the medical center still in withdrawal, anxious and doubtful about what would happen next.
At the care center, Stephanie still worried that CPS would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any time, someone could walk in and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” 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 those close to her always found ways to let her down. She did not know how to love herself, not to mention anyone else.
Every day, staff from the facility took her to a clinic for methadone, provided orally. Over time, she was embracing sobriety.
She spent every minute beyond therapy 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 sensory challenges and required an specialist – all frequent conditions for babies exposed to substances.
Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a decoration on her head, resting on the floor with the exit nearby. She is slender. Her posture is humble so you do not see her expression. She is presenting her daughter on her knee for the children to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “Why are there no men?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there given the chance.
“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 Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I would become a mother.”
Methods to address drug-exposed newborns have existed for decades.
The Finnegan NAS scale was created in 1975|
