Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had assembled in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. Withdrawal was setting in. She slumped forward and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before seeking medical help and had only a brief window to get treated before she had to return to relapse. She thought she still had several weeks to find a way to become sober and give birth.
The medical professional intervened. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was critical, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie delivered a baby girl weighing just over four pounds – premature, little but surviving.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she failed. She felt worthless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source would not provide to her when she became obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The widespread belief that her love for her baby would make her stop using only led to greater shame and negative self-talk, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to monitors, so tiny she thought she would break her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to call her daughter Izzie, after the professional who provided support to her.
Medical personnel told her about a specialized facility, a innovative treatment home where women and their babies are supported as a unit, not apart.
In many parts of America, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when families are kept intact, recovery succeeds, custody cases decrease and long-term costs decline.
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 bring her to the facility.
She departed the institution still in detox, fearful and unsure about what would come next.
At the care center, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could enter and take her baby away.
For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about survival. 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 let her down. She lacked the ability to value herself, not to mention anyone else.
Every day, staff from the facility drove her to a treatment center, provided orally. Over time, she was starting to get clean.
She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies exposed to substances.
When a child recognizes these infants need affection, then I could do this. I would become a mother.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She has an image of the moment. She is dressed in casual attire, a gray knit hat with a pompom on her head, sitting on the wooden floor with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her leg for the young ones 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 parents responded that the dads were busy, called away to other tasks, that they would be there if possible.
“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I would become a mother.”
Methods to address infants affected by substances have existed for decades.
The Finnegan NAS scale was established in 1975|
