She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Rescued Both Lives.
Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the ER after her infection worsened up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had constructed in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she had to return to use once more. She thought she still had a month remaining to figure out how to get clean and deliver her child.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was critical, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
A short time later, on a day in November 2022, Stephanie gave birth to a daughter weighing a small weight – premature, tiny yet healthy.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been administered shortly before she gave birth.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she failed. She felt hopeless, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her dealer refused to sell to her when she became obviously with child.
“However, I failed,” she said. “I had to seek support.”
The widespread belief that her bond with her newborn would make her recover only led to greater shame and self-harm, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.
The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to medical equipment, so little she thought she would break her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to give her child the name the same as her nurse, 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 supported as a unit, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, 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 the care home is demonstrating a key fact: when families are kept intact, results get better, foster placements fall and future expenses reduce.
It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to bring her to the facility.
She departed the institution still in withdrawal, anxious and doubtful about what would come next.
At Maddie’s Place, Stephanie still feared that authorities would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could walk in and separate them.
For the first two weeks, 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 enduring. Addiction came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to let her down. She did not know how to love herself, not to mention anyone else.
Daily, staff from Maddie’s Place transported her to a recovery program, provided orally. Gradually, she was embracing sobriety.
She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, stopped by with her own children in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She has an image of the moment. She is dressed in black pants and a hoodie, a beanie with a decoration on her head, seated on the ground with the door behind her. She is thin. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if possible.
“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I could be a mom.”
Methods to address drug-exposed newborns have existed for decades.
The evaluation method was developed in 1975|