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 hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and became sick.
Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”
She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and have this baby.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was critical, but physicians found she also had an leakage of amniotic fluid. 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 regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.
A short time later, on a day in November 2022, Stephanie delivered a daughter weighing a small weight – early, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” 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 ill. Ill-equipped for parenting. Undeserving.
Stephanie had sought recovery several times during pregnancy, and felt awful each time she was unsuccessful. She felt worthless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her supplier declined to supply to her when she became obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her quit only led to greater shame and self-harm, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was attached to tubes and leads, so little she thought she would hurt her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the attendant who showed compassion to her.
Hospital staff told her about Maddie’s Place, a new kind of care center where women and their babies are treated together, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when families are kept intact, outcomes improve, foster placements fall and overall savings increase.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, care providers came to bring her to the facility.
She departed the institution still in withdrawal, fearful and unsure about what would happen next.
At the facility, Stephanie still worried that CPS would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any point, someone could walk in and separate them.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about survival. Drugs came first; trust came last.
Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to cause pain. She was unable to care for herself, let alone anyone else.
Every day, staff from Maddie’s Place transported her to a recovery program, provided orally. Gradually, she was beginning recovery.
She devoted all her time beyond therapy 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 pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an professional – all common issues for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. An advocate, a recovery coach, visited with her own family in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet 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. “My past did not matter to them. None of those things mattered to them.”
She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a pompom on her head, seated on the ground with the door behind her. She is lean. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her knee for the young ones to see and they are crowding near, fawning and reaching out to the baby.
One child, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there if possible.
“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I would become a mother.”
Approaches for managing drug-exposed newborns have been available for years.
The Finnegan NAS scale was developed in 1975|