Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, Stephanie Rosell went to the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had built in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and became sick.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”
She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the leg infection was critical, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.
A short time later, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – early, tiny yet healthy.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been administered a few hours prior to birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she relapsed. She felt worthless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “just” 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 pervasive expectation that her bond with her newborn would make her stop using only led to greater shame and negative self-talk, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to tubes and leads, so small she thought she would hurt her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
After two days she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.
Nurses and doctors 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 much of the US, where a baby is found to have newborn addiction symptoms frequently, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, results get better, foster placements fall and future expenses reduce.
It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to bring her to the facility.
She left the medical center still in withdrawal, fearful and unsure about what would come next.
At the care center, Stephanie still worried that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter and take her baby away.
For the beginning period, Stephanie kept to herself. “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.”
Survival outdoors, she said, was about survival. Addiction came first; trust came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She lacked the ability to love herself, not to mention anyone else.
Daily, staff from the facility took her to a clinic for methadone, provided orally. Over time, she was beginning recovery.
She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all common issues for babies affected by withdrawal.
When a child recognizes these infants need affection, then I found the strength. I would become a mother.
During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She holds a picture of the moment. She is dressed in casual attire, a cap with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her lap for the other kids to see and they are crowding near, admiring and touching to the baby.
A young boy, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the dads were busy, engaged elsewhere, 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 exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I would become a mother.”
Tools for treating babies with exposure have existed for decades.
The assessment tool was established in 1975|
