She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Saved Them Both.
In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she lived in a shed she had built in a acquaintance's garden. She was also addicted to fentanyl.
As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”
She had consumed opioids before arriving at the hospital and had just enough time to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and give birth.
The attending nurse disagreed. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
After five days, on the 12th of November, Stephanie gave birth to a infant weighing 4lb 8oz – early, small but alive.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given a few hours prior to birth.
She felt sick. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her dealer declined to supply to her when she became obviously with child.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her recover only led to deeper self-loathing and self-harm, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was connected to monitors, so small she thought she would harm her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She remained uncertain 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.
Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.
In much of the US, where a baby is diagnosed with infant withdrawal condition frequently, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.
She departed the institution still in withdrawal, fearful and unsure about what would come next.
At Maddie’s Place, Stephanie still feared that CPS would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter and remove her child.
For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about enduring. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to let her down. She was unable to love herself, let alone anyone else.
Each day, staff from Maddie’s Place drove her to a clinic for methadone, given as medication. Over time, 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 infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an professional – all frequent conditions for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.
On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. An advocate, a recovery coach, stopped by with her own family in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a pompom on her head, resting on the floor with the door behind her. She is slender. Her face is downcast so you do not see her expression. She is lifting the baby on her knee for the young ones to see and they are standing close, showing interest to the baby.
A young boy, eight, asked the parents: “What about the fathers?” The parents responded that the dads were busy, called away to other tasks, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I would become a mother.”
Approaches for managing babies with exposure have been available for years.
The assessment tool was established in 1975|
