Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, Stephanie Rosell went to the medical facility after her infection worsened up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had built in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and get high.”
She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had a month remaining to plan her recovery and deliver her child.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie delivered a daughter weighing 4lb 8oz – born before term, little but surviving.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her last dose of fentanyl had been provided shortly before she gave birth.
She felt sick. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she failed. She felt without value, blaming herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I had to seek support.”
The widespread belief that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.
The infant was moved to the special care nursery. When Stephanie at last met her, she was attached to tubes and leads, so little she thought she would harm her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Nurses and doctors told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.
In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, recovery succeeds, fewer children enter care and overall savings increase.
It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to pick her up.
She departed the institution still in withdrawal, anxious and doubtful about what would come next.
At the facility, Stephanie still worried that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could enter and separate them.
For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about enduring. Substances came first; reliance came last.
Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to value herself, let alone anyone else.
Each day, staff from the center transported her to a treatment center, provided orally. Gradually, she was beginning recovery.
She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an occupational therapist – all typical problems for babies exposed to substances.
When a child recognizes these infants need affection, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. An advocate, a mentor, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She holds a picture of the moment. She is wearing casual attire, a cap with a bobble on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you miss her features. She is lifting the baby on her lap for the children to see and they are standing close, showing interest to the baby.
A young boy, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and her companion exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could parent.”
Methods to address babies with exposure have been used for a long time.
The evaluation method was developed in 1975|
