Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the ER after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and threw up.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
She had taken the drug before arriving at the hospital and had just enough time to get treated before she needed to go home to get high again. She thought she still had several weeks to figure out how to get clean and deliver her child.
The attending nurse disagreed. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.
Izzie persuaded 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 transitioned to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
After five days, on the 12th of November, Stephanie delivered a daughter weighing a small weight – born before term, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her epidural had failed, her last dose of fentanyl had been given a few hours prior to birth.
She felt unwell. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt without value, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her source would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her bond with her newborn would make her quit only led to deeper self-loathing and self-harm, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.
The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt empty. “I just stared 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 Izzie, after the professional who provided support to her.
Nurses and doctors told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.
In many parts of America, where a baby is found to have newborn addiction symptoms regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and overall savings increase.
It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to bring her to the facility.
She stepped out of the hospital still in withdrawal, fearful and unsure about what would happen next.
At the facility, Stephanie still worried that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could enter and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Substances came first; faith came last.
Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to hurt her. She did not know how to value herself, let alone anyone else.
Each day, staff from the center transported her to a treatment center, administered in pill form. Over time, she was beginning recovery.
She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had sensory challenges and required an specialist – all frequent conditions for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I was capable. I could be a mom.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. An advocate, a peer support specialist, stopped by with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She keeps a photo of the moment. She is clad in black pants and a hoodie, a cap with a decoration on her head, sitting on the wooden floor with the door behind her. She is slender. Her posture is humble so you cannot see her face. She is holding Izzie up on her leg for the children to see and they are gathered around, admiring and touching to the baby.
One child, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”
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 could do this. I would become a mother.”
Approaches for managing infants affected by substances have been used for a long time.
The evaluation method was developed in 1975|
