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 her infection worsened up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had assembled in a companion's property. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and threw up.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”
She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had four weeks left to figure out how to get clean and deliver her child.
The nurse had other ideas. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was serious, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
A short time later, on a day in November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – early, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given a few hours prior to birth.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had sought recovery repeatedly before birth, and felt horrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her dealer would not provide to her when she became obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The common assumption that her love for her baby would make her quit only led to deeper self-loathing and self-harm, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.
The baby was taken to the special care nursery. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would harm her. Cradling her initially, 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 name her baby the same as her nurse, after the professional who provided support to her.
Nurses and doctors told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like the care home is demonstrating a key fact: when families are kept intact, outcomes improve, fewer children enter care 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, a couple of employees came to pick her up.
She left the medical center still in detox, scared and uncertain about what would happen next.
At the facility, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could walk in and separate them.
For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about enduring. Drugs came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to cause pain. She did not know how to love herself, much less anyone else.
Each day, staff from the facility drove her to a clinic for methadone, administered in pill form. Slowly, she was starting to get clean.
She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all typical problems for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a mentor, stopped by with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The young ones stared in awe of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She holds a picture of the moment. She is clad in black pants and a hoodie, a cap with a pompom on her head, resting on the floor with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is presenting her daughter on her knee for the children to see and they are gathered around, showing interest to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could parent.”
Approaches for managing infants affected by substances have been used for a long time.
The Finnegan NAS scale was created in 1975|
