Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Pregnant and experiencing intense discomfort, Stephanie Rosell went to the ER after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and vomited.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had only a brief window to get treated before she needed to go home to relapse. She thought she still had a month remaining to plan her recovery and deliver her child.
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 leg infection was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie regulated amounts 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 often prescribed in addiction recovery.
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 caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.
She felt unwell. Unprepared to be a mother. Not fit.
Stephanie had tried to get clean several times during pregnancy, and felt awful each time she failed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her source refused to sell to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The widespread belief that her affection for her child would make her quit only led to deeper self-loathing and negative self-talk, a trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the special care nursery. When Stephanie eventually visited her, she was hooked up to tubes and leads, so small she thought she would hurt her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” 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.
Hospital staff told her about a specialized facility, a unique recovery environment where women and their babies are cared for jointly, not apart.
In numerous states, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like this facility is proving a simple point: when families are kept intact, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to pick her up.
She departed the institution still in recovery, anxious and doubtful about what would happen next.
At the care center, Stephanie still worried that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could arrive and separate them.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to let her down. She was unable to value herself, let alone anyone else.
Every day, staff from the facility drove her to a clinic for methadone, administered in pill form. Gradually, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an specialist – all typical problems for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
During a pre-holiday visit, Stephanie was in the common room, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, came over with her own family in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a cap with a bobble on her head, sitting on the wooden floor with the exit nearby. She is lean. Her head is tilted forward so you do not see her expression. She is lifting the baby on her knee for the young ones to see and they are gathered around, fawning and reaching out to the baby.
Jacob, eight, asked the parents: “Why are there no men?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could be a mom.”
Approaches for managing infants affected by substances have existed for decades.
The Finnegan NAS scale was created in 1975|
