Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the medical facility after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also addicted to fentanyl.
As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and threw up.
Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”
She had taken the drug before arriving at the hospital and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.
A short time later, on a day in November 2022, Stephanie delivered a daughter weighing 4lb 8oz – early, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her last dose of fentanyl had been administered a few hours prior to birth.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had sought recovery multiple times while expecting, and felt horrible each time she relapsed. She felt hopeless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her source refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I needed help.”
The pervasive expectation that her love for her baby would make her recover only led to greater shame and self-harm, a trigger 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 newborn was transferred to the NICU. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name after her caregiver, after the professional who provided support to her.
Nurses and doctors told her about a care center, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.
In many parts of America, where a baby is diagnosed with infant withdrawal condition frequently, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a small, growing network of centers like this facility is proving a simple point: when parents and infants remain united, recovery succeeds, custody cases decrease and future expenses reduce.
It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to collect her.
She left the medical center still in recovery, scared and uncertain about what would follow.
At the care center, Stephanie still feared that authorities would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter and separate them.
For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about survival. Drugs came first; reliance came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She was unable to value herself, much less anyone else.
Daily, staff from the facility took her to a clinic for methadone, given as medication. Over time, she was beginning recovery.
She utilized each moment 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 sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges 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 was capable. I could parent.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a recovery coach, visited with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She holds a picture of the moment. She is wearing casual attire, a gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. She is lean. Her posture is humble so you cannot see her face. 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.
A young boy, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could be a mom.”
Methods to address infants affected by substances have existed for decades.
The Finnegan NAS scale was established in 1975|
