She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also dependent on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and vomited.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had consumed opioids before coming to the ER and had only a brief window to get treated before she had to return to get high again. She thought she still had a month remaining to plan her recovery 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 amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, 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 commonly used in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing a small weight – early, little but surviving.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been given shortly before she gave birth.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her quit only led to deeper self-loathing and negative self-talk, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to tubes and leads, so little she thought she would harm her. Holding her for the first time, she felt empty. “I looked at 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 after her caregiver, after the professional who provided support to her.
Nurses and doctors told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a small, growing network of centers like the care home is demonstrating a key fact: when families are kept intact, outcomes improve, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, care providers came to pick her up.
She departed the institution still in detox, scared and uncertain about what would come next.
At the facility, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any point, someone could arrive and remove her child.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about enduring. Substances came first; reliance came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to value herself, much less anyone else.
Every day, staff from the center drove her to a recovery program, provided orally. Over time, she was embracing sobriety.
She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.
On a day prior to the holiday, Stephanie was in the common room, where those still using can come for supervised visits with their babies. An advocate, a peer support specialist, came over with her own family in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” 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 wearing casual attire, a gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. She is slender. Her face is downcast so you miss her features. She is presenting her daughter on her knee for the young ones to see and they are gathered around, admiring and touching to the baby.
A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if possible.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could parent.”
Methods to address babies with exposure have been available for years.
The evaluation method was established in 1975|
