Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
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 resided in a small structure she had constructed 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 leaned over the bed and threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”
She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was severe, but physicians found she also had an ruptured membrane. 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 periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – born before term, tiny yet healthy.
When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been provided four hours before delivery.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she failed. She felt hopeless, berating herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her supplier would not provide to her when she became clearly expecting.
“But I couldn’t,” she said. “I required assistance.”
The widespread belief that her affection for her child would make her recover only led to increased guilt and negative self-talk, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was hooked up to tubes and leads, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.
Hospital staff told her about a specialized facility, 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 found to have neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when families are kept intact, results get better, fewer children enter care and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to collect her.
She left the medical center still in detox, fearful and unsure about what would follow.
At the care center, Stephanie still feared that CPS would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any point, someone could arrive and separate them.
For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about survival. Drugs came first; trust came last.
Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to love herself, let alone anyone else.
Daily, staff from Maddie’s Place transported her to a clinic for methadone, given as medication. Over time, she was starting to get clean.
She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all common issues for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a peer support specialist, visited with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She keeps a photo of the moment. She is clad in casual attire, a gray knit hat with a bobble on her head, sitting on the wooden floor with the door behind her. She is lean. Her face is downcast so you miss her features. She is presenting her daughter on her lap for the young ones to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if they could.
“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could parent.”
Approaches for managing babies with exposure have been used for a long time.
The evaluation method was developed in 1975|
