Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Pregnant and experiencing intense discomfort, Stephanie Rosell went to the hospital emergency room after her infection worsened up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also addicted to fentanyl.
As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. 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 was compelled to leave to relapse. She thought she still had a month remaining 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 doctors would not let her go: the condition in her limbs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities 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 often prescribed in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – born before term, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her pain relief did not work, her final administration of fentanyl had been administered four hours before delivery.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she relapsed. She felt worthless, criticizing herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her source declined to supply to her when she became clearly expecting.
“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 negative self-talk, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.
The infant was moved to the NICU. When Stephanie eventually visited her, she was connected to medical equipment, so small she thought she would harm her. Cradling her initially, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name the same as her nurse, after the professional who provided support to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, foster placements fall and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, care providers came to collect her.
She left the medical center still in recovery, anxious and doubtful about what would follow.
At the facility, Stephanie still was concerned that child services would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could walk in and take her baby away.
For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Substances came first; reliance came last.
Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She did not know how to care for herself, much less anyone else.
Each day, staff from the center drove her to a treatment center, given as medication. Gradually, she was embracing sobriety.
She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all common issues for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I could be a mom.
On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The young ones stared in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She holds a picture of the moment. She is dressed in black pants and a hoodie, a beanie with a decoration on her head, sitting on the wooden floor with the door behind her. She is slender. 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, admiring and touching to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there given the chance.
“When I have kids,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could be a mom.”
Methods to address drug-exposed newborns have been available for years.
The Finnegan NAS scale was established in 1975|
