Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Pregnant and experiencing intense discomfort, Stephanie Rosell visited the ER after a serious infection started to spread 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 dependent on fentanyl.
As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”
She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and deliver her child.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was serious, but physicians found 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.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.
Five days later, on the 12th of November, Stephanie delivered a daughter weighing 4lb 8oz – premature, tiny yet healthy.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her pain relief did not work, her final administration of fentanyl had been provided a few hours prior to birth.
She felt unwell. Unprepared to be a mother. Not fit.
Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she failed. She felt without value, berating herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her source would not provide to her when she became visibly pregnant.
“Yet I was unable,” she said. “I needed help.”
The widespread belief that her love for her baby would make her recover only led to deeper self-loathing and self-harm, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.
The newborn was transferred to the NICU. When Stephanie eventually visited her, she was attached to medical equipment, so tiny she thought she would harm her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain 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.
Hospital staff told her about a care center, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a developing system of centers like this facility is showing an important truth: when mothers and babies stay together, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, care providers came to collect her.
She left the medical center still in detox, fearful and unsure about what would happen next.
At the facility, Stephanie still feared that CPS would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could arrive and separate them.
For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about enduring. Substances came first; faith came last.
Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to let her down. She lacked the ability to care for herself, much less anyone else.
Daily, staff from Maddie’s Place drove her to a clinic for methadone, given as medication. Over time, 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 daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. An advocate, a peer support specialist, stopped by with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” 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 clad in black pants and a hoodie, a beanie with a pompom on her head, seated on the ground with the exit nearby. She is slender. Her face is downcast so you cannot see her face. She is lifting the baby on her leg for the young ones to see and they are gathered around, admiring and touching to the baby.
One child, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I would become a mother.”
Approaches for managing babies with exposure have been used for a long time.
The assessment tool was established in 1975|
