Fentanyl Addiction During Pregnancy: How Keeping Her Baby Rescued Both Lives.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the medical facility after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had built in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and became sick.
Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”
She had used fentanyl before arriving at the hospital and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to find a way to become sober and deliver her child.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the infection in her legs was severe, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, 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 medication that eases withdrawal and is often prescribed in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie had a infant weighing a small weight – premature, small but alive.
When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given shortly before she gave birth.
She felt ill. Ill-equipped for parenting. Undeserving.
Stephanie had sought recovery multiple times while expecting, and felt terrible each time she failed. She felt worthless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her dealer would not provide to her when she became clearly expecting.
“However, I failed,” she said. “I needed help.”
The common assumption that her bond with her newborn would make her stop using only led to greater shame and negative self-talk, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to tubes and leads, so small she thought she would hurt her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to call her daughter the same as her nurse, after the professional who provided support to her.
Medical personnel told her about a care center, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.
In many parts of America, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like the care home is proving a simple point: when families are kept intact, 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, a couple of employees came to bring her to the facility.
She left the medical center still in detox, scared and uncertain about what would come next.
At the facility, Stephanie still feared that authorities would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any point, someone could walk in and separate them.
For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”
Homelessness, she said, was about getting by. Addiction came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She did not know how to care for herself, much less anyone else.
Each day, staff from the center transported her to a recovery program, administered in pill form. Gradually, she was starting to get clean.
She devoted all her time 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 severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all typical problems for babies affected by withdrawal.
When a child recognizes these infants need affection, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. An advocate, a recovery coach, came over with her own children in tow to deliver baked goods. 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 had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo of the moment. She is clad in black pants and a hoodie, a gray knit hat with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her knee for the children to see and they are gathered around, showing interest to the baby.
One child, eight, asked the parents: “Where are all the dads?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I would become a mother.”
Methods to address babies with exposure have existed for decades.
The Finnegan NAS scale was developed in 1975|
