She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
Pregnant and experiencing intense discomfort, Stephanie Rosell visited the ER after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had built in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and threw up.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”
She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had several weeks to plan her recovery and deliver her child.
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 condition in her limbs was severe, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.
Five days later, on the 12th of November, Stephanie gave birth to a daughter weighing a small weight – premature, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been administered four hours before delivery.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery several times during pregnancy, and felt terrible each time she failed. She felt worthless, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her source refused to sell to her when she became clearly expecting.
“But I couldn’t,” she said. “I needed help.”
The common assumption that her love for her baby would make her stop using only led to greater shame and negative self-talk, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was attached to tubes and leads, so tiny she thought she would hurt her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.
Nurses and doctors told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is proving a simple point: when families are kept intact, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to pick her up.
She left the medical center still in recovery, fearful and unsure about what would come next.
At Maddie’s Place, Stephanie still worried that CPS would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could enter and remove her child.
For the initial fortnight, Stephanie remained isolated. “I avoided interaction,” 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; trust came last.
Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She lacked the ability to love herself, let alone anyone else.
Daily, staff from the center drove her to a recovery program, provided orally. Gradually, she was beginning recovery.
She devoted all her time when not in sessions 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 pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, sitting on the wooden floor with the exit nearby. She is thin. Her face is downcast so you do not see her expression. She is holding Izzie up on her leg for the other kids to see and they are standing close, showing interest to the baby.
A young boy, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there given the chance.
“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and her companion exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could be a mom.”
Approaches for managing drug-exposed newborns have been available for years.
The Finnegan NAS scale was created in 1975|
