She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had constructed in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”
She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had a month remaining to plan her recovery and deliver her child.
The medical professional intervened. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.
Five days later, on 12 November 2022, Stephanie had a baby girl weighing just over four pounds – premature, tiny yet healthy.
When the nurse asked if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her pain relief did not work, her last dose of fentanyl had been given a few hours prior to birth.
She felt sick. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her source would not provide to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her recover only led to deeper self-loathing and self-harm, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.
The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt nothing. “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 Izzie, after the professional who provided support to her.
Nurses and doctors 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 identified with infant withdrawal condition regularly, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like the care home is showing an important truth: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to pick her up.
She stepped out of the hospital still in recovery, scared and uncertain about what would come next.
At the care center, Stephanie still was concerned that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could walk in and take her baby away.
For the beginning period, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Drugs came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to let her down. She was unable to value herself, not to mention anyone else.
Each day, staff from the center transported her to a clinic for methadone, provided orally. Over time, she was embracing sobriety.
She devoted all her time outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an professional – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, 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 children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She holds a picture of the moment. She is wearing black pants and a hoodie, a cap with a decoration on her head, seated on the ground with the door behind her. She is slender. Her face is downcast so you miss her features. She is presenting her daughter on her lap for the other kids to see and they are gathered around, admiring and touching to the baby.
A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the dads were busy, handling responsibilities, 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 looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could parent.”
Approaches for managing babies with exposure have been available for years.
The Finnegan NAS scale was created in 1975|
