She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell visited the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”
She had consumed opioids before coming to the ER and had sufficient opportunity 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 have this baby.
The attending nurse disagreed. 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 serious, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.
A short time later, on 12 November 2022, Stephanie delivered a infant weighing a small weight – premature, tiny yet healthy.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been given shortly before she gave birth.
She felt unwell. Unprepared to be a mother. Unworthy.
Stephanie had sought recovery repeatedly before birth, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her dealer declined to supply to her when she became obviously with child.
“But I couldn’t,” she said. “I had to seek support.”
The widespread belief that her affection for her child would make her quit only led to increased guilt and negative self-talk, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The newborn was transferred to the NICU. When Stephanie at last met her, she was attached to monitors, so little she thought she would harm her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby after her caregiver, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is proving a simple point: when parents and infants remain united, outcomes improve, 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 verifying her eligibility for the program, two staff members came to pick her up.
She stepped out of the hospital still in detox, anxious and doubtful about what would follow.
At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and remove her child.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Drugs came first; faith came last.
Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She was unable to love herself, let alone anyone else.
Daily, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Gradually, she was starting to get clean.
She devoted all her time 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 obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an specialist – all typical problems for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.
On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” 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 clad in casual attire, a beanie with a decoration on her head, resting on the floor with the door behind her. She is lean. Her face is downcast so you cannot see her face. She is presenting her daughter on her lap for the other kids to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the moms: “What about the fathers?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if they could.
“When I have kids,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I would become a mother.”
Approaches for managing drug-exposed newborns have been available for years.
The assessment tool was created in 1975|
