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 ER after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a companion's property. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. The onset of withdrawal began. She slumped forward and threw up.
Stephanie eventually collapsed. “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 needed to go home to get high again. She thought she still had a month remaining to find a way to become sober and have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
A short time later, on 12 November 2022, Stephanie delivered a baby girl weighing a small weight – born before term, tiny yet healthy.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she relapsed. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her supplier refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I needed help.”
The pervasive expectation that her love for her baby would make her recover only led to deeper self-loathing and negative self-talk, a cause for her to use again. 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 neonatal intensive care unit. When Stephanie at last met her, she was attached to monitors, so tiny she thought she would hurt her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.
Hospital staff told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.
In numerous states, where a baby is diagnosed with infant withdrawal condition regularly, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is demonstrating a key fact: when mothers and babies stay together, results get better, fewer children enter care 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, two staff members came to collect her.
She left the medical center still in recovery, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still feared that authorities would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could arrive and separate them.
For the beginning period, Stephanie stayed withdrawn. “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 survival. Addiction came first; trust came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She did not know how to care for herself, much less anyone else.
Daily, staff from the facility drove her to a clinic for methadone, administered in pill form. Gradually, she was beginning recovery.
She devoted all her time outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all typical problems for babies born with NAS.
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 remained in the shared space, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, visited with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing black pants and a hoodie, a gray knit hat with a decoration on her head, seated on the ground with the door behind her. She is lean. Her head is tilted forward so you do not see her expression. She is lifting the baby on her lap for the children to see and they are standing close, showing interest to the baby.
One child, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I would become a mother.”
Approaches for managing infants affected by substances have been available for years.
The Finnegan NAS scale was established in 1975|
