A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Transformed Their Futures.
In her eighth month of pregnancy and suffering, Stephanie Rosell visited the ER after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had constructed in a companion's property. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and vomited.
Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids 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 four weeks left to plan her recovery and have this baby.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was critical, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
Five days later, on 12 November 2022, Stephanie had a baby girl weighing 4lb 8oz – born before term, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, 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 terrible each time she failed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The common assumption that her bond with her newborn would make her recover only led to greater shame and negative self-talk, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the NICU. When Stephanie at last met her, she was connected to monitors, so small she thought she would harm her. Embracing her at last, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to name her baby after her caregiver, after the attendant who showed compassion to her.
Nurses and doctors told her about Maddie’s Place, a new kind of care center 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 frequently, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a small, growing network of centers like this facility is proving a simple point: when families are kept intact, results get better, foster placements fall and overall savings increase.
It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.
She departed the institution still in detox, anxious and doubtful about what would come next.
At the care center, Stephanie still feared that authorities would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter and take her baby away.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about survival. Drugs came first; faith came last.
Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She was unable to care for herself, much less anyone else.
Daily, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Over time, she was beginning recovery.
She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges 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 was capable. I would become a mother.
On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a peer support specialist, came over with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She has an image of the moment. She is dressed in black pants and a hoodie, a cap with a bobble on her head, resting on the floor with the exit nearby. She is thin. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her leg for the children to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “What about the fathers?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if they could.
“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could be a mom.”
Approaches for managing infants affected by substances have been used for a long time.
The Finnegan NAS scale was established in 1975|