She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, Stephanie Rosell visited the ER after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had built in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and became sick.
Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home to relapse. She thought she still had four weeks left to find a way to become sober and deliver her child.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the doctors would not let her go: the infection in her legs was severe, 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.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.
Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing a small weight – born before term, little but surviving.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been provided shortly before she gave birth.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she relapsed. She felt hopeless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her supplier would not provide to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The common assumption that her bond with her newborn would make her stop using only led to greater shame and self-harm, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.
The baby was taken to the NICU. When Stephanie eventually visited her, she was connected to tubes and leads, so little she thought she would hurt her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to name her baby Izzie, after the attendant who showed compassion to her.
Medical personnel told her about a care center, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a developing system of centers like the care home is showing an important truth: when families are kept intact, outcomes improve, custody cases decrease and overall savings increase.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to collect her.
She stepped out of the hospital still in detox, anxious and doubtful about what would happen next.
At the facility, Stephanie still was concerned that authorities would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could enter and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about enduring. Addiction came first; faith came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to care for herself, not to mention anyone else.
Daily, staff from Maddie’s Place drove her to a recovery program, administered in pill form. Gradually, she was starting to get clean.
She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all typical problems for babies exposed to substances.
Seeing that even a young person understands the need for care, then I could do this. I could be a mom.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” 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 gray knit hat with a pompom on her head, sitting on the wooden floor with the door behind her. She is lean. Her face is downcast so you cannot see her face. She is presenting her daughter on her lap for the young ones to see and they are gathered around, showing interest to the baby.
One child, 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 they could.
“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”
Methods to address babies with exposure have been available for years.
The assessment tool was developed in 1975|
