She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Rescued Both Lives.
Eight months pregnant and in severe pain, Stephanie Rosell went to the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had assembled in a companion's property. She was also hooked on fentanyl.
As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and threw up.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had taken the drug before seeking medical help and had just enough time to get treated before she needed to go home to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.
After five days, on a day in November 2022, Stephanie had a baby girl weighing a small weight – premature, little but surviving.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was detached. Her epidural had failed, her previous intake 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 several times during pregnancy, and felt horrible each time she relapsed. She felt worthless, blaming herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her source refused to sell to her when she became visibly pregnant.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her recover only led to deeper self-loathing and self-harm, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was hooked up to tubes and leads, so little she thought she would harm her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to name her baby Izzie, after the nurse who had been so kind to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In numerous states, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, results get better, fewer children enter care and overall savings increase.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She departed the institution still in withdrawal, anxious and doubtful about what would happen next.
At Maddie’s Place, Stephanie still was concerned that CPS would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could walk in and separate them.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to value herself, much less anyone else.
Every day, staff from the facility drove her to a clinic for methadone, given as medication. Over time, she was beginning recovery.
She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She has an image of the moment. She is wearing casual attire, a gray knit hat with a decoration on her head, seated on the ground with the door behind her. She is slender. Her head is tilted forward so you cannot see her face. She is lifting the baby on her leg for the young ones to see and they are crowding near, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if possible.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. 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 newborns require care, then I was able. I could be a mom.”
Approaches for managing drug-exposed newborns have been used for a long time.
The assessment tool was developed in 1975|
