A Pregnant Woman's Battle with Fentanyl Addiction: Choosing Motherhood Rescued Both Lives.

Eight months pregnant and in severe pain, Stephanie Rosell went to the medical facility after an infection began spreading up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She slumped forward and threw up.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”

She had taken the drug before seeking medical help and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had several weeks to find a way to become sober and have this baby.

The nurse had other ideas. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was critical, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – early, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been provided a few hours prior to birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she failed. She felt hopeless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source would not provide to her when she became obviously with child.

“But I couldn’t,” she said. “I had to seek support.”

The widespread belief that her affection for her child would make her stop using only led to greater shame and self-harm, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to monitors, so little she thought she would hurt her. Cradling her initially, 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.

Following a brief period she decided to name her baby Izzie, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) 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 demonstrating a key fact: when parents and infants remain united, results get better, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.

She departed the institution still in withdrawal, fearful and unsure about what would come next.

At the care center, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could enter and take her baby away.

For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about getting by. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She was unable to value herself, much less anyone else.

Daily, staff from the facility transported her to a clinic for methadone, provided orally. Gradually, she was beginning recovery.

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 nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a cap with a decoration on her head, sitting on the wooden floor with the door behind her. She is slender. Her face is downcast so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are crowding near, admiring and touching to the baby.

Jacob, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there given the chance.

“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 looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could be a mom.”

Methods to address infants affected by substances have been used for a long time.

The Finnegan NAS scale was created in 1975|