Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
In her eighth month of pregnancy and suffering, Stephanie Rosell went to the ER after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had built in a acquaintance's garden. She was also hooked on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and became sick.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”
She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she had to return to relapse. She thought she still had a month remaining to figure out how to get clean and deliver her child.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
A short time later, on a day in November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, small but alive.
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 unwell. Not ready for motherhood. Not fit.
Stephanie had sought recovery several times during pregnancy, and felt terrible each time she relapsed. She felt without value, blaming herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her source would not provide to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her affection for her child would make her quit only led to greater shame and negative self-talk, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was attached to tubes and leads, so small she thought she would break her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.
Nurses and doctors told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.
In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like the care home is proving a simple point: when parents and infants remain united, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to bring her to the facility.
She stepped out of the hospital still in detox, scared and uncertain about what would follow.
At the care center, Stephanie still worried that CPS would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could arrive and separate them.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to cause pain. She did not know how to care for herself, let alone anyone else.
Every day, staff from the center transported her to a treatment center, given as medication. Over time, she was starting to get clean.
She devoted all her time when not in sessions 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 obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.
During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. An advocate, a recovery coach, stopped by with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo 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 door behind her. She is lean. Her face is downcast so you cannot see her face. She is holding Izzie up on her knee for the other kids to see and they are crowding near, fawning and reaching out to the baby.
Jacob, eight, asked the moms: “Where are all the dads?” The parents responded that the men were occupied, called away to other tasks, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could be a mom.”
Approaches for managing babies with exposure have been used for a long time.
The evaluation method was developed in 1975|
