She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, Stephanie Rosell visited the ER after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had built in a acquaintance's garden. She was also hooked on fentanyl.
As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and became sick.
Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”
She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to plan her recovery and give birth.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the leg infection was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
Five days later, on a day in November 2022, Stephanie gave birth to a daughter weighing just over four pounds – premature, little but surviving.
When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.
She felt ill. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became obviously with child.
“However, I failed,” she said. “I needed help.”
The common assumption that her bond with her newborn would make her quit only led to greater shame and self-harm, 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 newborn was transferred to the NICU. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would harm her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure 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.
Hospital staff told her about a specialized facility, a unique recovery environment where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and overall savings increase.
It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, care providers came to pick her up.
She departed the institution still in withdrawal, scared and uncertain about what would follow.
At the facility, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and remove her child.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Substances came first; faith came last.
Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She was unable to value herself, much less anyone else.
Every day, staff from the center transported her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.
She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an professional – 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.
On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” 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 wearing black pants and a hoodie, a cap with a pompom on her head, sitting on the wooden floor with the exit nearby. She is thin. Her head is tilted forward so you do not see her expression. She is lifting the baby on her leg for the young ones to see and they are gathered around, admiring and touching to the baby.
One child, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there if possible.
“When I have kids,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I could parent.”
Approaches for managing babies with exposure have been used for a long time.
The evaluation method was developed in 1975|