She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Rescued Both Lives.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the medical facility after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she resided in a small structure she had built in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and vomited.
Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”
She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober and give birth.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was serious, 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.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.
Five days later, on the 12th of November, Stephanie had a infant weighing a small weight – premature, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she relapsed. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became clearly expecting.
“But I couldn’t,” she said. “I required assistance.”
The common assumption that her bond with her newborn would make her quit only led to greater shame and self-abuse, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to tubes and leads, so tiny she thought she would hurt her. Embracing her at last, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to call her daughter 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 parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is demonstrating a key fact: when families are kept intact, recovery succeeds, fewer children enter care and long-term costs decline.
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, care providers came to collect her.
She departed the institution still in recovery, scared and uncertain about what would come next.
At the facility, Stephanie still feared that child services would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could walk in and separate them.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about getting by. Drugs came first; reliance came last.
Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She did not know how to care for herself, much less anyone else.
Each day, staff from Maddie’s Place took her to a treatment center, given as medication. Over time, she was starting to get clean.
She devoted all her time when not in sessions 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 obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I could parent.
On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a peer support specialist, visited with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in awe of the tiny infant 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 casual attire, a cap with a bobble on her head, sitting on the wooden floor with the exit nearby. She is lean. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the children to see and they are crowding near, admiring and touching to the baby.
A young boy, eight, asked the moms: “Where are all the dads?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there if possible.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I would become a mother.”
Tools for treating babies with exposure have been used for a long time.
The Finnegan NAS scale was developed in 1975|
