Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Pregnant and experiencing intense discomfort, Stephanie Rosell visited the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also hooked on fentanyl.
As physicians addressed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to plan her recovery and deliver her child.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.
Five days later, on the 12th of November, Stephanie had a baby girl weighing a small weight – born before term, little but surviving.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been administered a few hours prior to birth.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery repeatedly before birth, and felt horrible each time she relapsed. She felt hopeless, blaming herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her source refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The widespread belief that her love for her baby would make her stop using only led to deeper self-loathing and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was attached to medical equipment, so tiny she thought she would break her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Two days later she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.
Medical personnel told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.
In many parts of America, where a baby is diagnosed with infant withdrawal condition frequently, 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 proving a simple point: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to collect her.
She left the medical center still in withdrawal, fearful and unsure about what would happen next.
At Maddie’s Place, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could walk in and take her baby away.
For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about survival. Addiction came first; reliance came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to love herself, let alone anyone else.
Daily, staff from Maddie’s Place took her to a recovery program, administered in pill form. Gradually, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all common issues for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits 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 resting on the carpet holding Izzie.
The young ones stared in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her head is tilted forward so you do not see her expression. She is lifting the baby on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.
Jacob, eight, asked the moms: “What about the fathers?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if possible.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could be a mom.”
Tools for treating babies with exposure have been used for a long time.
The assessment tool was created in 1975|
