Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, Stephanie Rosell went to the medical facility after an infection began spreading up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and vomited.
Stephanie eventually collapsed. “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 was compelled to leave to relapse. She thought she still had a month remaining to plan her recovery and give birth.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was serious, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she departed, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
After five days, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – premature, tiny yet healthy.
When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been given shortly before she gave birth.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had sought recovery repeatedly before birth, and felt awful each time she relapsed. She felt without value, berating herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her source would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her love for her baby would make her stop using only led to greater shame and self-harm, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was hooked up to medical equipment, so little she thought she would break her. Cradling her initially, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to name her baby after her caregiver, after the attendant who showed compassion to her.
Nurses and doctors told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group 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 long-term costs decline.
It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to bring her to the facility.
She left the medical center still in recovery, fearful and unsure about what would follow.
At the care center, Stephanie still feared that child services would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could walk in and take her baby away.
For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence 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 relationship was delicate. The people she loved always found ways to hurt her. She was unable to love herself, much less anyone else.
Every day, staff from the facility transported her to a recovery program, provided orally. Gradually, she was embracing sobriety.
She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.
On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. A support specialist, a mentor, visited with her own children in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” 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 dressed in casual attire, a cap with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her knee for the children to see and they are standing close, showing interest to the baby.
One child, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, called away to other tasks, that they would be there given the chance.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could be a mom.”
Methods to address drug-exposed newborns have been used for a long time.
The evaluation method was established in 1975|
