Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, Stephanie Rosell visited the medical facility after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had built in a companion's property. She was also hooked on fentanyl.
As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had several weeks to plan her recovery and deliver her child.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the leg infection was severe, 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 be at risk of death.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten 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 addiction recovery.
Five days later, on 12 November 2022, Stephanie had a baby girl weighing a small weight – born before term, little but surviving.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.
She felt ill. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her dealer refused to sell to her when she became obviously with child.
“However, I failed,” she said. “I required assistance.”
The common assumption that her affection for her child would make her stop using only led to deeper self-loathing and negative self-talk, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.
The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was attached to monitors, so tiny she thought she would break her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
After two days she decided to call her daughter Izzie, after the nurse who had been so kind to her.
Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, where a baby is diagnosed with infant withdrawal condition frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when families are kept intact, outcomes improve, foster placements fall and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to collect her.
She departed the institution still in detox, scared and uncertain about what would happen next.
At the care center, Stephanie still worried that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could enter and take her baby away.
For the beginning period, Stephanie remained isolated. “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.”
Homelessness, she said, was about getting by. Substances came first; reliance came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She lacked the ability to value herself, let alone anyone else.
Each day, staff from the facility drove her to a clinic for methadone, provided orally. Slowly, she was beginning recovery.
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 adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all typical problems for babies exposed to substances.
Seeing that even a young person understands the need for care, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a mentor, stopped by with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor 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. “My past did not matter to them. 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, seated on the ground with the door behind her. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her lap for the other kids to see and they are crowding near, showing interest to the baby.
One child, eight, asked the moms: “Why are there no men?” The parents responded that the men were occupied, 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 her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I could be a mom.”
Methods to address babies with exposure have been available for years.
The Finnegan NAS scale was established in 1975|
