She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had assembled in a companion's property. She was also dependent on fentanyl.
As doctors treated her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”
She had consumed opioids before seeking medical help and had only a brief window to get treated before she needed to go home to relapse. She thought she still had several weeks to find a way to become sober and deliver her child.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.
A short time later, on the 12th of November, Stephanie gave birth to a baby girl weighing just over four pounds – premature, little but surviving.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been given shortly before she gave birth.
She felt unwell. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her source declined to supply to her when she became clearly expecting.
“However, I failed,” she said. “I required assistance.”
The pervasive expectation that her love for her baby would make her stop using only led to greater shame and negative self-talk, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt nothing. “I gazed upon 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 give her child the name the same as her nurse, after the professional who provided support to her.
Nurses and doctors told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.
In much of the US, where a baby is found to have newborn addiction symptoms regularly, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and overall savings increase.
It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to collect her.
She departed the institution still in detox, fearful and unsure about what would come next.
At the facility, Stephanie still was concerned that CPS would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could arrive and take her baby away.
For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about enduring. Addiction came first; reliance came last.
Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to value herself, let alone anyone else.
Every day, staff from the facility drove her to a treatment center, provided orally. Gradually, she was starting to get clean.
She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an professional – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a peer support specialist, visited with her own children in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She holds a picture of the moment. She is dressed in casual attire, a gray knit hat with a bobble on her head, seated on the ground with the exit nearby. She is lean. Her posture is humble so you miss her features. She is presenting her daughter on her knee for the other kids to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if possible.
“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I would become a mother.”
Approaches for managing infants affected by substances have existed for decades.
The assessment tool was established in 1975|
