Fentanyl Addiction During Pregnancy: How Keeping Her Baby Rescued Both Lives.
Eight months pregnant and in severe pain, Stephanie Rosell went to the medical facility after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had taken the drug before arriving at the hospital and had just enough time to get treated before she had to return to relapse. She thought she still had several weeks to find a way to become sober and give birth.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
After five days, on a day in November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – early, small but alive.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her epidural had failed, her last dose of fentanyl had been provided four hours before delivery.
She felt sick. Ill-equipped for parenting. Undeserving.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier declined to supply to her when she became clearly expecting.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her quit only led to greater shame and negative self-talk, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.
The baby was taken to the special care nursery. When Stephanie eventually visited her, she was hooked up to monitors, so tiny she thought she would harm her. Cradling her initially, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to name her baby Izzie, after the professional who provided support to her.
Nurses and doctors told her about a care center, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a developing system of centers like the care home is proving a simple point: when families are kept intact, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, care providers came to pick her up.
She stepped out of the hospital still in recovery, fearful and unsure about what would follow.
At the facility, Stephanie still feared that child services would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could arrive and separate them.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Homelessness, she said, was about getting by. Drugs came first; trust came last.
Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She lacked the ability to care for herself, let alone anyone else.
Every day, staff from the center took her to a treatment center, 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 infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all frequent conditions for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. An advocate, a recovery coach, visited with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She has an image of the moment. She is wearing casual attire, a beanie with a decoration on her head, seated on the ground with the exit nearby. She is slender. Her face is downcast so you miss her features. She is lifting the baby on her leg for the young ones to see and they are gathered around, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The parents responded that the dads were busy, called away to other tasks, that they would be there if possible.
“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could parent.”
Approaches for managing drug-exposed newborns have been available for years.
The Finnegan NAS scale was developed in 1975|