Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, Stephanie Rosell went to the ER after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”
She had consumed opioids before arriving at the hospital and had just enough time to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober and give birth.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.
After five days, on the 12th of November, Stephanie delivered a baby girl weighing just over four pounds – born before term, tiny yet healthy.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.
She felt ill. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.
“However, I failed,” she said. “I required assistance.”
The common assumption that her love for her baby would make her stop using only led to deeper self-loathing and self-abuse, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.
The baby was taken 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 just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
After two days she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.
In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still rushed to special care 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 mothers and babies stay together, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.
She departed the institution still in detox, scared and uncertain about what would follow.
At the facility, Stephanie still feared that authorities would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could enter and take her baby away.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about getting by. Drugs came first; faith came last.
Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to cause pain. She did not know how to care for herself, not to mention anyone else.
Each day, staff from the center drove her to a clinic for methadone, administered in pill form. Over time, she was starting to get clean.
She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an specialist – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I could do this. I could parent.
During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. An advocate, a recovery coach, stopped by with her own family in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a beanie with a pompom on her head, seated on the ground with the entryway at her back. She is slender. Her face is downcast so you do not see her expression. She is holding Izzie up on her lap for the young ones to see and they are standing close, fawning and reaching out to the baby.
Jacob, eight, asked the moms: “Why are there no men?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could be a mom.”
Tools for treating drug-exposed newborns have been available for years.
The assessment tool was developed in 1975|
