Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
Pregnant and experiencing intense discomfort, Stephanie Rosell went to the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”
She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and give birth.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the doctors would not let her go: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.
After five days, on 12 November 2022, Stephanie had a infant weighing a small weight – born before term, tiny yet healthy.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was detached. Her epidural had failed, her previous intake of fentanyl had been given shortly before she gave birth.
She felt unwell. Not ready for motherhood. Unworthy.
Stephanie had sought recovery several times during pregnancy, and felt horrible each time she failed. She felt worthless, criticizing herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her supplier would not provide to her when she became visibly pregnant.
“But I couldn’t,” she said. “I needed help.”
The widespread belief that her affection for her child would make her stop using only led to increased guilt and self-abuse, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The newborn was transferred to the NICU. When Stephanie at last met her, she was hooked up to monitors, so little she thought she would harm her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
After two days she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.
Medical personnel told her about a care center, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.
In many parts of America, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to collect her.
She stepped out of the hospital still in detox, fearful and unsure about what would come next.
At the facility, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could arrive and remove her child.
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 survival. Drugs came first; reliance came last.
Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to hurt her. She lacked the ability to love herself, much less anyone else.
Every day, staff from the center transported her to a clinic for methadone, given as medication. Gradually, she was starting to get clean.
She utilized each moment outside treatment 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 obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an professional – all common issues for babies affected by withdrawal.
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 parents in active addiction can come for supervised visits with their babies. An advocate, a peer support specialist, stopped by with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor 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. Such issues were irrelevant.”
She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, seated on the ground with the entryway at her back. She is slender. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her leg for the children to see and they are gathered around, fawning and reaching out to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if they could.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could parent.”
Methods to address drug-exposed newborns have existed for decades.
The assessment tool was established in 1975|
