Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
In her eighth month of pregnancy and suffering, Stephanie Rosell visited the ER after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had assembled in a companion's property. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and threw up.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to plan her recovery and have this baby.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was critical, 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 face grave danger.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.
Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – premature, little but surviving.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided shortly before she gave birth.
She felt ill. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, berating 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.
“However, I failed,” she said. “I needed help.”
The common assumption that her love for her baby would make her stop using only led to greater shame and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.
The infant was moved to the NICU. When Stephanie at last met her, she was attached to medical equipment, so small she thought she would hurt her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to give her child the name 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 supported as a unit, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is showing an important truth: when families are kept intact, results get better, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to pick her up.
She departed the institution still in detox, scared and uncertain about what would follow.
At the care center, Stephanie still feared that CPS would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could enter and take her baby away.
For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about survival. Addiction came first; reliance came last.
Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to cause pain. She lacked the ability to care for herself, not to mention anyone else.
Daily, staff from the center took her to a clinic for methadone, given as medication. Over time, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an professional – all typical problems for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.
During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by with her own children in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a beanie with a pompom on her head, sitting on the wooden floor with the door behind her. She is lean. Her posture is humble so you cannot see her face. She is holding Izzie up on her lap for the children to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if they could.
“When I have kids,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could parent.”
Approaches for managing drug-exposed newborns have been available for years.
The Finnegan NAS scale was established in 1975|
