Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, 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. Symptoms of withdrawal emerged. She bent over the bedside and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to find a way to become sober and give birth.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.
After five days, on 12 November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – born before term, tiny yet healthy.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been administered four hours before delivery.
She felt sick. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she failed. She felt without value, berating herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her dealer declined to supply to her when she became obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The widespread belief that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, 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 baby was taken to the NICU. When Stephanie at last met her, she was hooked up to tubes and leads, so small she thought she would break her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to call her daughter after her caregiver, after the professional who provided support to her.
Medical personnel told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.
In numerous states, where a baby is identified with newborn addiction symptoms frequently, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, outcomes improve, fewer children enter care and long-term costs decline.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to collect her.
She left the medical center still in withdrawal, fearful and unsure about what would happen next.
At Maddie’s Place, Stephanie still feared that authorities would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could enter and take her baby away.
For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about getting by. Drugs came first; reliance came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She lacked the ability to value herself, not to mention anyone else.
Daily, staff from the facility transported her to a treatment center, provided orally. Over time, she was starting to get clean.
She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in awe of the small baby 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 dressed in casual attire, a beanie with a pompom on her head, resting on the floor with the exit nearby. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.
Jacob, eight, asked the mothers: “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 if possible.
“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I would become a mother.”
Approaches for managing drug-exposed newborns have existed for decades.
The assessment tool was developed in 1975|