She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Saved Them Both.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at 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 hooked on fentanyl.
As doctors treated her infection, she began to panic. Withdrawal was setting in. She slumped forward and became sick.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”
She had consumed opioids before coming to the ER 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 find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.
Five days later, on a day in November 2022, Stephanie had a baby girl weighing just over four pounds – early, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been given a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Unworthy.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, berating herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her supplier would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I needed help.”
The common assumption that her affection for her child would make her quit only led to increased guilt and self-abuse, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would hurt her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, outcomes improve, custody cases decrease and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, care providers came to collect her.
She departed the institution still in recovery, scared and uncertain about what would happen next.
At the care center, Stephanie still feared that child services would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any time, someone could walk in and take her baby away.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Drugs came first; reliance came last.
Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to cause pain. She did not know how to value herself, much less anyone else.
Daily, staff from Maddie’s Place transported her to a recovery program, administered in pill form. Gradually, she was starting to get clean.
She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an specialist – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I could do this. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is clad in casual attire, a cap with a pompom on her head, sitting on the wooden floor with the door behind her. She is lean. Her head is tilted forward so you do not see her expression. She is presenting her daughter 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 parents: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I could parent.”
Approaches for managing drug-exposed newborns have been available for years.
The assessment tool was developed in 1975|
