She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Rescued Both Lives.
Eight months pregnant and in severe pain, Stephanie Rosell visited the hospital emergency room 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 assembled in a acquaintance's garden. She was also hooked on fentanyl.
As physicians addressed her infection, she began to panic. Withdrawal was setting in. She slumped forward and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
She had taken the drug before coming to the ER and had only a brief window to get treated before she needed to go home to relapse. She thought she still had a month remaining 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 hospital refused to discharge 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.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.
After five days, on the 12th of November, Stephanie delivered a infant weighing a small weight – premature, small but alive.
When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been administered a few hours prior to birth.
She felt unwell. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she relapsed. She felt worthless, blaming herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her dealer refused to sell to her when she became clearly expecting.
“Yet I was unable,” she said. “I needed help.”
The widespread belief that her bond with her newborn would make her stop using only led to greater shame and self-abuse, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to monitors, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, a new kind of care center where women and their babies are treated together, not apart.
In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, results get better, fewer children enter care and future expenses reduce.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to collect her.
She departed the institution still in detox, fearful and unsure about what would come next.
At the care center, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could walk in and remove her child.
For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about survival. Addiction came first; reliance came last.
Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to cause pain. She did not know how to value herself, let alone anyone else.
Each day, staff from Maddie’s Place transported her to a recovery program, provided orally. Slowly, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an professional – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I would become a mother.
On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, came over with her own children in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She holds a picture of the moment. She is dressed in casual attire, a cap with a pompom on her head, seated on the ground with the door behind her. She is thin. Her face is downcast so you miss her features. She is presenting her daughter on her knee for the young ones to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the moms: “Where are all the dads?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if they could.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could be a mom.”
Approaches for managing infants affected by substances have existed for decades.
The evaluation method was developed in 1975|
