Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Eight months pregnant and in severe pain, 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 built in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”
She had used fentanyl before seeking medical help and had just enough time to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and give birth.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in rehabilitation.
After five days, on the 12th of November, Stephanie delivered a infant weighing a small weight – born before term, little but surviving.
When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been administered a few hours prior to birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her supplier declined to supply to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The widespread belief that her love for her baby would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the NICU. When Stephanie eventually visited her, she was connected to medical equipment, so little she thought she would harm her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the attendant who showed compassion to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.
In many parts of America, where a baby is diagnosed with infant withdrawal condition regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to collect her.
She left the medical center still in recovery, anxious and doubtful about what would happen next.
At the facility, Stephanie still worried that authorities would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could arrive and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about getting by. Substances came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to hurt her. She did not know how to care for herself, much less anyone else.
Each day, staff from the center transported her to a recovery program, given as medication. Over time, she was beginning recovery.
She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues 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 parent.
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 mentor, came over with her own children 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 wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She has an image of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a pompom on her head, resting on the floor with the exit nearby. She is thin. Her head is tilted forward so you do not see her expression. She is lifting the baby on her leg for the children to see and they are gathered around, fawning and reaching out to the baby.
One child, eight, asked the parents: “Why are there no men?” The parents responded 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 will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could be a mom.”
Methods to address infants affected by substances have been used for a long time.
The Finnegan NAS scale was developed in 1975|
