She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell went to the ER after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and threw up.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she had to return to use once more. She thought she still had a month remaining to find a way to become sober and give birth.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the doctors would not let her go: the condition in her limbs 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 be at risk of death.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
Five days 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 embrace her child, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been given a few hours prior to birth.
She felt unwell. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she was unsuccessful. She felt without value, criticizing herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her dealer refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The pervasive expectation that her love for her baby would make her quit only led to increased guilt and self-abuse, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.
The baby was taken to the special care nursery. When Stephanie eventually visited her, she was attached to monitors, so small she thought she would hurt her. Embracing her at last, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.
Hospital staff told her about a care center, a innovative treatment home 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 whisked to NICUs and medicated while their mothers face custody evaluations. But a developing system of centers like the care home is showing an important truth: when mothers and babies stay together, results get better, fewer children enter care and overall savings increase.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to collect her.
She departed the institution still in withdrawal, scared and uncertain about what would follow.
At the facility, Stephanie still was concerned that child services would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any point, someone could walk in and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Substances came first; reliance came last.
Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to cause pain. She did not know how to value herself, not to mention anyone else.
Each day, staff from Maddie’s Place drove her to a clinic for methadone, given as medication. Gradually, she was starting to get clean.
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 sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all common issues for babies affected by withdrawal.
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 remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She has an image of the moment. She is wearing casual attire, a beanie with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her posture is humble so you do not see her expression. She is lifting the baby on her knee for the children to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, 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 the specialist looked at each other. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I could be a mom.”
Approaches for managing infants affected by substances have existed for decades.
The assessment tool was established in 1975|
