Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had assembled in a companion's property. 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 finally broke down. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to find a way to become sober and deliver her child.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
After five days, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – born before term, tiny yet healthy.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her epidural had failed, her previous intake of fentanyl had been given shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her dealer declined to supply to her when she became clearly expecting.
“Yet I was unable,” she said. “I needed help.”
The common assumption that her affection for her child would make her quit only led to increased guilt and self-abuse, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the NICU. When Stephanie finally saw her her, she was connected to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt nothing. “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 nurse who had been so kind to her.
Medical personnel told her about Maddie’s Place, a innovative treatment home where women and their babies are supported as a unit, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, 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, a couple of employees came to collect her.
She departed the institution still in detox, scared and uncertain about what would follow.
At Maddie’s Place, Stephanie still was concerned that CPS would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could arrive and separate them.
For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to let her down. She did not know how to care for herself, not to mention anyone else.
Every day, staff from the center transported her to a recovery program, given as medication. Over time, she was beginning recovery.
She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an professional – all common issues for babies exposed to substances.
Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.
On a day prior to the holiday, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. An advocate, a mentor, stopped by with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, resting on the floor with the door behind her. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the other kids to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “What about the fathers?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if they could.
“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could parent.”
Methods to address drug-exposed newborns have been available for years.
The Finnegan NAS scale was created in 1975|
