Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the ER after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had built in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and threw up.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”
She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had several weeks to figure out how to get clean and have this baby.
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 infection in her legs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would not survive.
She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.
Five days later, on a day in November 2022, Stephanie had a daughter weighing 4lb 8oz – early, little but surviving.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been given a few hours prior to birth.
She felt ill. Not ready for motherhood. Not fit.
Stephanie had tried to get clean several times during pregnancy, and felt awful each time she relapsed. She felt hopeless, criticizing herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her supplier declined to supply to her when she became obviously with child.
“But I couldn’t,” she said. “I needed help.”
The widespread belief that her bond with her newborn would make her stop using only led to increased guilt and self-abuse, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to monitors, so tiny she thought she would harm her. Embracing her at last, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
After two days she decided to name her baby the same as her nurse, after the professional who provided support to her.
Medical personnel told her about a specialized facility, a innovative treatment home where women and their babies are supported as a unit, not apart.
In numerous states, 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 custody evaluations. But a developing system of centers like this facility is showing an important truth: when mothers and babies stay together, results get better, custody cases decrease and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to bring her to the facility.
She stepped out of the hospital still in recovery, scared and uncertain about what would follow.
At the care center, 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 time, someone could arrive and take her baby away.
For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about survival. Substances came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to cause pain. She was unable to value herself, let alone anyone else.
Every day, staff from the center drove her to a recovery program, given as medication. Slowly, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity 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 would become a mother.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. A support specialist, a recovery coach, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The young ones stared in awe of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She has an image of the moment. She is dressed in casual attire, a beanie with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her face is downcast so you cannot see her face. She is presenting her daughter on her leg for the children to see and they are gathered around, fawning and reaching out to the baby.
One child, eight, asked the parents: “Why are there no men?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there if they could.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could parent.”
Approaches for managing drug-exposed newborns have existed for decades.
The assessment tool was created in 1975|