Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.

Eight months pregnant and in severe pain, Stephanie Rosell arrived at the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had constructed in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and became sick.

Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”

She had taken the drug before coming to the ER and had just enough time to get treated before she had to return to get high again. She thought she still had four weeks left to find a way to become sober and have this baby.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the leg infection was serious, but medical staff detected 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.

She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.

After five days, on 12 November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – early, small but alive.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her final administration of fentanyl had been given a few hours prior to birth.

She felt unwell. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she failed. She felt without value, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her supplier would not provide to her when she became visibly pregnant.

“Yet I was unable,” she said. “I had to seek support.”

The pervasive expectation that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.

The baby was taken to the special care nursery. When Stephanie eventually visited her, she was connected to tubes and leads, so little she thought she would break her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition regularly, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a developing system of centers like the care home is demonstrating a key fact: when mothers and babies stay together, results get better, foster placements fall and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to pick her up.

She left the medical center still in detox, fearful and unsure about what would come next.

At the facility, Stephanie still feared that child services would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and remove her child.

For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about survival. Substances came first; trust came last.

Stephanie had a single companion, but even that bond was fragile. The individuals she cared for always found ways to let her down. She was unable to value herself, not to mention anyone else.

Every day, staff from the center transported her to a treatment center, provided orally. Gradually, she was beginning recovery.

She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies born with NAS.

When a child recognizes these infants need affection, then I could do this. I could parent.

One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. An advocate, a peer support specialist, stopped by with her own family in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She keeps a photo of the moment. She is clad in black pants and a hoodie, a cap with a decoration on her head, resting on the floor with the door behind her. She is slender. Her posture is humble so you miss her features. She is lifting the baby on her knee for the young ones to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could parent.”

Methods to address drug-exposed newborns have been available for years.

The assessment tool was created in 1975|