Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, Stephanie Rosell went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had built in a companion's property. She was also addicted to fentanyl.
As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”
She had used fentanyl before seeking medical help and had just enough time to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and have this baby.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.
After five days, on the 12th of November, Stephanie gave birth to a daughter weighing 4lb 8oz – early, little but surviving.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.
She felt sick. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt awful each time she was unsuccessful. She felt without value, berating herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her source refused to sell to her when she became clearly expecting.
“But I couldn’t,” she said. “I had to seek support.”
The common assumption that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.
The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt empty. “I looked at 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 Izzie, after the nurse who had been so kind to her.
Nurses and doctors told her about a specialized facility, a new kind of care center where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, results get better, foster placements fall and overall savings increase.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to pick her up.
She departed the institution still in recovery, scared and uncertain about what would come next.
At the facility, Stephanie still feared that authorities would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could walk in and take her baby away.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about enduring. Drugs came first; trust came last.
Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to hurt her. She did not know how to value herself, let alone anyone else.
Every day, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Over time, she was embracing sobriety.
She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies born with NAS.
When a child recognizes these infants need affection, then I could do this. I would become a mother.
On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a peer support specialist, came over with her own family in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She keeps a photo of the moment. She is dressed in casual attire, a gray knit hat with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her posture is humble so you cannot see her face. She is lifting the baby on her knee for the other kids to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the moms: “What about the fathers?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could parent.”
Methods to address infants affected by substances have been available for years.
The assessment tool was created in 1975|
