She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell went to the ER after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and threw up.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she needed to go home to get high again. She thought she still had four weeks left to figure out how to get clean and deliver her child.
The medical professional intervened. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, small but alive.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her epidural had failed, her previous intake of fentanyl had been administered shortly before she gave birth.
She felt sick. Not ready for motherhood. Not fit.
Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she relapsed. She felt without value, blaming herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her dealer declined to supply to her when she became clearly expecting.
“However, I failed,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her recover only led to increased guilt and self-harm, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to name her baby Izzie, after the attendant who showed compassion to her.
Medical personnel told her about a care center, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.
In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, results get better, fewer children enter care and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.
She departed the institution still in recovery, scared and uncertain about what would come next.
At the facility, Stephanie still feared that authorities would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could arrive and separate them.
For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about enduring. Drugs came first; faith came last.
Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to let her down. She lacked the ability to love herself, let alone anyone else.
Every day, staff from Maddie’s Place transported her to a treatment center, given as medication. Slowly, she was embracing sobriety.
She utilized each moment beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies born with NAS.
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 was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a mentor, stopped by with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She has an image of the moment. She is clad in casual attire, a gray knit hat with a pompom on her head, seated on the ground with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is holding Izzie up on her lap for the other kids to see and they are standing close, admiring and touching to the baby.
A young boy, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if possible.
“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could be a mom.”
Methods to address infants affected by substances have been available for years.
The Finnegan NAS scale was created in 1975|
