Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell went to the medical facility after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had several weeks to figure out how to get clean and give birth.
The medical professional intervened. 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 severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.
After five days, on the 12th of November, Stephanie delivered a daughter weighing a small weight – born before term, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been provided a few hours prior to birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had sought recovery several times during pregnancy, and felt terrible each time she was unsuccessful. She felt worthless, berating herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The widespread belief that her affection for her child would make her quit only led to greater shame and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to call her daughter Izzie, after the nurse who had been so kind to her.
Nurses and doctors 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 many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is showing an important truth: when mothers and babies stay together, results get better, custody cases decrease and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, two staff members came to pick her up.
She departed the institution still in detox, fearful and unsure about what would follow.
At the care center, Stephanie still feared that CPS would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could walk in and take her baby away.
For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She did not know how to value herself, let alone anyone else.
Daily, staff from the center took her to a recovery program, provided orally. Gradually, she was starting to get clean.
She spent every minute outside treatment 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.
When a child recognizes these infants need affection, then I could do this. I could parent.
During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in wonder of the tiny infant 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 keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, sitting on the wooden floor with the door behind her. She is slender. Her face is downcast so you cannot see her face. She is presenting her daughter on her knee for the children to see and they are crowding near, admiring and touching to the baby.
One child, eight, asked the mothers: “Where are all the dads?” The parents responded that the dads were busy, called away to other tasks, that they would be there given the chance.
“When I have kids,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could parent.”
Approaches for managing babies with exposure have been used for a long time.
The Finnegan NAS scale was developed in 1975|
