Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the hospital emergency room after an infection began spreading up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”
She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had four weeks left to figure out how to get clean and give birth.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.
A short time later, on the 12th of November, Stephanie had a daughter weighing just over four pounds – born before term, small but alive.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been administered a few hours prior to birth.
She felt ill. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she failed. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her source refused to sell to her when she became visibly pregnant.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her stop using only led to increased guilt and negative self-talk, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.
The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to monitors, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the nurse who had been so kind to her.
Medical personnel told her about a care center, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.
In numerous states, where a baby is diagnosed with newborn addiction symptoms frequently, 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 demonstrating a key fact: when families are kept intact, results get better, foster placements fall and overall savings increase.
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 stepped out of the hospital still in detox, scared and uncertain about what would come next.
At the facility, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could walk in and remove her child.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about enduring. Addiction 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 hurt her. She did not know how to love herself, not to mention anyone else.
Every day, staff from the facility transported her to a clinic for methadone, administered in pill form. Over time, she was embracing sobriety.
She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an occupational therapist – all typical problems for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I could do this. I could parent.
On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. A support specialist, a peer support specialist, stopped by with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, seated on the ground with the exit nearby. She is thin. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her knee for the other kids to see and they are crowding near, admiring and touching to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I would become a mother.”
Methods to address babies with exposure have been available for years.
The evaluation method was created in 1975|
