Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the ER after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had assembled in a companion's property. She was also addicted to fentanyl.
As physicians addressed her infection, she began to panic. Withdrawal was setting in. She slumped forward and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”
She had taken the drug 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 several weeks to figure out how to get clean and deliver her child.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the infection in her legs was critical, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.
A short time later, on a day in November 2022, Stephanie gave birth to a daughter weighing just over four pounds – born before term, tiny yet healthy.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been administered a few hours prior to birth.
She felt sick. Not ready for motherhood. Unworthy.
Stephanie had sought recovery multiple times while expecting, and felt horrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her supplier would not provide to her when she became obviously with child.
“However, I failed,” she said. “I needed help.”
The common assumption that her love for her baby would make her quit only led to greater shame and self-abuse, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was hooked up to monitors, so tiny she thought she would break her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to give her child the name the same as her nurse, after the professional who provided support to her.
Medical personnel told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like this facility is showing an important truth: when mothers and babies stay together, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, two staff members came to pick her up.
She departed the institution still in withdrawal, fearful and unsure about what would happen next.
At the facility, Stephanie still worried that child services would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and separate them.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about getting by. Addiction came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to hurt her. She was unable to care for herself, not to mention anyone else.
Every day, staff from the center drove her to a treatment center, given as medication. Over time, she was embracing sobriety.
She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.
On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, resting on the floor with the entryway at her back. She is thin. Her face is downcast so you cannot see her face. She is presenting her daughter on her knee for the young ones to see and they are gathered around, showing interest to the baby.
A young boy, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the men were occupied, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I found the courage. I could parent.”
Tools for treating drug-exposed newborns have been available for years.
The evaluation method was established in 1975|
