Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she lived in a shed she had constructed in a acquaintance's garden. She was also dependent on fentanyl.
As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and became sick.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before coming to the ER and had just enough time to get treated before she had to return to use once more. She thought she still had several weeks to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, 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 abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
After five days, on 12 November 2022, Stephanie had a infant weighing a small weight – born before term, little but surviving.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.
She felt unwell. Not ready for motherhood. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her quit only led to deeper self-loathing and self-abuse, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.
The baby was taken to the NICU. When Stephanie eventually visited her, she was hooked up to tubes and leads, so small she thought she would break her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
After two days she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.
Nurses and doctors told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.
In many parts of America, where a baby is identified with infant withdrawal condition frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, fewer children enter care and long-term costs decline.
It took Stephanie some time to build confidence to call, but she finally did. After confirming she would be a good fit for the program, care providers came to collect her.
She left the medical center still in withdrawal, anxious and doubtful about what would come next.
At the care center, Stephanie still feared that CPS would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could enter and take her baby away.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Drugs came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to hurt her. She lacked the ability to value herself, much less anyone else.
Each day, staff from Maddie’s Place transported her to a treatment center, 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 obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all common issues for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. A support specialist, a peer support specialist, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She keeps a photo of the moment. She is clad in casual attire, a cap with a pompom on her head, seated on the ground with the door behind her. She is slender. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are crowding near, showing interest to the baby.
A young boy, eight, asked the mothers: “Where are all the dads?” The parents responded that the men were occupied, 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. They will know they are valued.”
Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”
Methods to address babies with exposure have been used for a long time.
The Finnegan NAS scale was developed in 1975|
