Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.

Pregnant and experiencing intense discomfort, Stephanie Rosell went to the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had built in a friend’s yard. She was also addicted to fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”

She had consumed opioids before seeking medical help and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had several weeks to find a way to become sober and give birth.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.

Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – early, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been administered a few hours prior to birth.

She felt sick. Ill-equipped for parenting. Not fit.

Stephanie had sought recovery multiple times while expecting, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her supplier would not provide to her when she became visibly pregnant.

“But I couldn’t,” she said. “I required assistance.”

The widespread belief that her bond with her newborn would make her stop using only led to greater shame and negative self-talk, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.

The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would harm her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like this facility is proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to collect her.

She stepped out of the hospital still in detox, fearful and unsure about what would come next.

At the facility, Stephanie still worried that authorities 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 beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about survival. Addiction came first; trust came last.

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She did not know how to care for herself, not to mention anyone else.

Daily, staff from the center drove her to a treatment center, administered in pill form. Over time, she was beginning recovery.

She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a peer support specialist, visited with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She holds a picture of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a bobble on her head, resting on the floor with the exit nearby. She is thin. 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 standing close, admiring and touching to the baby.

One child, eight, asked the parents: “Why are there no men?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if possible.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I would become a mother.”

Tools for treating drug-exposed newborns have existed for decades.

The Finnegan NAS scale was established in 1975|