Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a companion's property. She was also dependent on fentanyl.
As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home 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 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 amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.
Five days later, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – premature, small but alive.
When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been administered a few hours prior to birth.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, berating herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier 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 recover only led to deeper self-loathing and self-abuse, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the NICU. When Stephanie at last met her, she was hooked up to monitors, so small she thought she would break her. Cradling her initially, 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.
Following a brief period she decided to call her daughter Izzie, after the professional who provided support to her.
Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, 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 custody evaluations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, results get better, custody cases decrease and future expenses reduce.
It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to pick her up.
She departed the institution still in withdrawal, anxious and doubtful about what would follow.
At the facility, Stephanie still feared that CPS would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could arrive and separate them.
For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Addiction 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 was unable to value herself, let alone anyone else.
Daily, staff from the center transported her to a clinic for methadone, provided orally. Gradually, she was starting to get clean.
She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all frequent conditions for babies exposed to substances.
When a child recognizes these infants need affection, then I could do this. I would become a mother.
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 recovery coach, came over with her own family in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in wonder 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 wearing black pants and a hoodie, a gray knit hat with a bobble on her head, seated on the ground with the door behind her. She is thin. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are standing close, fawning and reaching out to the baby.
Jacob, eight, asked the moms: “What about the fathers?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if possible.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could be a mom.”
Tools for treating drug-exposed newborns have been used for a long time.
The assessment tool was established in 1975|
