Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the medical facility after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had assembled in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”
She had consumed opioids before coming to the ER and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to find a way to become sober and deliver her child.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the leg infection was critical, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.
After five days, on a day in November 2022, Stephanie had a baby girl weighing 4lb 8oz – early, tiny yet healthy.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her epidural had failed, her final administration of fentanyl had been given four hours before delivery.
She felt unwell. Unprepared to be a mother. Not fit.
Stephanie had sought recovery multiple times while expecting, and felt terrible each time she was unsuccessful. She felt hopeless, berating herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her supplier declined to supply to her when she became clearly expecting.
“But I couldn’t,” she said. “I required assistance.”
The pervasive expectation that her affection for her child would make her stop using only led to increased guilt and self-harm, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.
The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would hurt her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Hospital staff told her about Maddie’s Place, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to bring her to the facility.
She left the medical center still in detox, anxious and doubtful about what would come next.
At the care center, Stephanie still worried that authorities would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could walk in and take her baby away.
For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about enduring. Substances came first; reliance came last.
Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She did not know how to care for herself, let alone anyone else.
Daily, staff from the facility took her to a treatment center, administered in pill form. Over time, she was beginning recovery.
She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an occupational therapist – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, then I was capable. I would become a mother.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, came over with her own children in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She has an image of the moment. She is clad in black pants and a hoodie, a beanie with a bobble on her head, resting on the floor with the exit nearby. She is slender. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her lap for the children to see and they are gathered around, showing interest to the baby.
A young boy, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there given the chance.
“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “When a child recognized 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 evaluation method was established in 1975|
