Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had assembled in a companion's property. She was also dependent on fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and became sick.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”
She had taken the drug 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 a month remaining to plan her recovery and have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was critical, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.
Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – early, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been given a few hours prior to birth.
She felt sick. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety 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 OBGYN told her to “only” stop using. Even her dealer would not provide to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her affection for her child would make her quit 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 overcome a persistent condition.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was attached to tubes and leads, so little she thought she would hurt her. Embracing her at last, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt 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 a specialized facility, a new kind of care center where parents and infants affected by substance use are treated together, 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 child-protection investigations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, recovery succeeds, fewer children enter care and long-term costs decline.
It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.
She departed the institution still in withdrawal, anxious and doubtful about what would come next.
At Maddie’s Place, Stephanie still feared that CPS would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter and separate them.
For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about enduring. Addiction came first; faith came last.
Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to care for herself, much less anyone else.
Each day, staff from the facility took her to a recovery program, provided orally. Over time, she was embracing sobriety.
She devoted all her time when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
During a pre-holiday visit, Stephanie remained in the shared space, 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 drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing casual attire, a beanie with a pompom on her head, sitting on the wooden floor with the door behind her. She is thin. Her posture is humble so you cannot see her face. She is holding Izzie up on her lap for the young ones to see and they are standing close, admiring and touching to the baby.
Jacob, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if possible.
“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 just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could be a mom.”
Tools for treating babies with exposure have existed for decades.
The evaluation method was established in 1975|
