She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a friend’s yard. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”
She had used fentanyl before arriving at the hospital and had just enough time to get treated before she needed to go home to get high again. She thought she still had a month remaining to figure out how to get clean and have this baby.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the medical facility declined to release her: the leg infection was critical, but physicians found she also had an leakage of amniotic fluid. 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 at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie gave birth to a daughter weighing just over four pounds – born before term, tiny yet healthy.
When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been given a few hours prior to birth.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt awful each time she failed. She felt without value, criticizing herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her dealer refused to sell to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The widespread belief that her affection for her child would make her recover only led to increased guilt and self-harm, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was connected to medical equipment, so small she thought she would harm her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to name her baby after her caregiver, after the professional who provided support to her.
Nurses and doctors told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In many parts of America, where a baby is found to have infant withdrawal condition regularly, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is proving a simple point: when families are kept intact, outcomes improve, fewer children enter care and overall savings increase.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to pick her up.
She departed the institution still in detox, anxious and doubtful about what would come next.
At the care center, Stephanie still worried that child services would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could enter and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about survival. Addiction came first; faith came last.
Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to cause pain. She did not know how to love herself, let alone anyone else.
Every day, staff from the center drove her to a treatment center, provided orally. Over time, she was embracing sobriety.
She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all frequent conditions for babies born with NAS.
Seeing that even a young person understands the need for care, 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 supervised visits with their babies. Katie Bunch-Smith, a mentor, visited with her own five kids in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She has an image of the moment. She is dressed in black pants and a hoodie, a beanie with a bobble on her head, resting on the floor with the entryway at her back. She is thin. Her posture is humble so you cannot see her face. She is lifting the baby on her leg for the other kids to see and they are standing close, fawning and reaching out to the baby.
One child, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there if possible.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could be a mom.”
Methods to address drug-exposed newborns have been available for years.
The Finnegan NAS scale was created in 1975|
