She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the ER after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had built in a friend’s yard. She was also hooked on fentanyl.
As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”
She had taken the drug before seeking medical help and had just enough time to get treated before she needed to go home to get high again. She thought she still had a month remaining to figure out how to get clean and have this baby.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.
The nurse convinced 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 transitioned to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie delivered a infant weighing a small weight – born before term, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been administered shortly before she gave birth.
She felt sick. Ill-equipped for parenting. Undeserving.
Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she failed. She felt without value, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source declined to supply to her when she became obviously with child.
“But I couldn’t,” she said. “I had to seek support.”
The widespread belief that her love for her baby would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The newborn was transferred to the NICU. When Stephanie finally saw her her, she was connected to monitors, so tiny she thought she would hurt her. Holding her for the first time, 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.
After two days she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.
Hospital staff told her about a care center, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, recovery succeeds, fewer children enter care and future expenses reduce.
It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She stepped out of the hospital still in withdrawal, anxious and doubtful about what would come next.
At Maddie’s Place, Stephanie still was concerned that child services would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could arrive and take her baby away.
For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She was unable to care for herself, let alone anyone else.
Each day, staff from the facility transported her to a clinic for methadone, provided orally. Slowly, she was starting to get clean.
She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. An advocate, a peer support specialist, visited with her own children in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She keeps a photo of the moment. She is dressed in casual attire, a cap with a bobble on her head, resting on the floor with the entryway at her back. She is lean. Her face is downcast so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are gathered around, showing interest to the baby.
One child, eight, asked the parents: “What about the fathers?” The parents responded 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 will excel as a father. I will teach them about love.”
Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I found the courage. I could be a mom.”
Approaches for managing drug-exposed newborns have existed for decades.
The Finnegan NAS scale was created in 1975|
