Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had assembled in a acquaintance's garden. She was also addicted to fentanyl.
As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”
She had consumed opioids before coming to the ER and had only a brief window to get treated before she needed to go home to get high again. She thought she still had four weeks left to figure out how to get clean and give birth.
The nurse had other ideas. 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 serious, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.
Five days later, on 12 November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – early, small but alive.
When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was detached. Her pain relief did not work, her final administration of fentanyl had been provided a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she failed. She felt without value, berating herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her source declined to supply to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The widespread belief that her bond with her newborn would make her recover only led to deeper self-loathing and negative self-talk, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the NICU. When Stephanie finally saw her her, she was connected to medical equipment, so little she thought she would harm her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Nurses and doctors told her about a care center, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.
In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like this facility is demonstrating a key fact: when families are kept intact, outcomes improve, foster placements fall and future expenses reduce.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to pick her up.
She left the medical center still in withdrawal, fearful and unsure about what would happen next.
At Maddie’s Place, Stephanie still worried that authorities would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any point, someone could enter and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Homelessness, she said, was about getting by. Drugs came first; reliance came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She lacked the ability to value herself, much less anyone else.
Every day, staff from the facility transported her to a clinic for methadone, given as medication. Slowly, she was beginning recovery.
She utilized each moment beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all frequent conditions for babies affected by withdrawal.
When a child recognizes these infants need affection, then I could do this. I would become a mother.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a peer support specialist, visited with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor 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 wearing black pants and a hoodie, a beanie with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her lap for the other kids to see and they are standing close, fawning and reaching out to the baby.
One child, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and Bunch-Smith exchanged glances. “I broke down,” 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 babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
