Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
In her eighth month of pregnancy and suffering, Stephanie Rosell went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had assembled in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and threw up.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to plan her recovery and have this baby.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
The nurse convinced 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 medication that eases withdrawal and is frequently utilized in rehabilitation.
A short time later, on the 12th of November, Stephanie had a infant weighing just over four pounds – early, small but alive.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her epidural had failed, her previous intake of fentanyl had been given four hours before delivery.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her dealer refused to sell to her when she became obviously with child.
“But I couldn’t,” 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-harm, a trigger for her to relapse. 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 attached to medical equipment, so small she thought she would break her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to call her daughter 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 mothers and their drug-exposed newborns are treated together, not apart.
In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to pick her up.
She stepped out of the hospital still in recovery, fearful and unsure about what would follow.
At the care center, Stephanie still was concerned that CPS would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any point, someone could enter and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about survival. Substances came first; trust came last.
Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to hurt her. She did not know how to value herself, much less anyone else.
Daily, staff from Maddie’s Place drove her to a clinic for methadone, administered in pill form. Over time, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I could do this. I could be a mom.
During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. A support specialist, a mentor, visited with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She has an image of the moment. She is dressed in black pants and a hoodie, a cap with a pompom on her head, sitting on the wooden floor with the door behind her. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her lap for the children to see and they are crowding near, admiring and touching to the baby.
A young boy, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. 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 was able. I would become a mother.”
Tools for treating infants affected by substances have been available for years.
The assessment tool was developed in 1975|
