A Pregnant Woman's Battle with Fentanyl Addiction: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, 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 resided in a small structure she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. Withdrawal was setting in. She slumped forward and threw up.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”
She had taken the drug before coming to the ER and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to figure out how to get clean and deliver her child.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was critical, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in addiction recovery.
After five days, on the 12th of November, Stephanie had a baby girl weighing just over four pounds – premature, little but surviving.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been administered a few hours prior to birth.
She felt ill. Not ready for motherhood. Not fit.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her supplier declined to supply to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her bond with her newborn would make her stop using only led to increased guilt and negative self-talk, a impetus for her to return to drugs. Yet she could not just wish 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 at last met her, she was attached to medical equipment, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt 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.
Hospital staff told her about a specialized facility, a new kind of care center where women and their babies are treated together, not apart.
In much of the US, where a baby is identified with infant withdrawal condition regularly, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to pick her up.
She left the medical center still in withdrawal, anxious and doubtful about what would happen next.
At Maddie’s Place, Stephanie still feared that child services would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could arrive and remove her child.
For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about survival. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to care for herself, not to mention anyone else.
Every day, staff from the center transported her to a clinic for methadone, provided orally. Over time, she was starting to get clean.
She utilized each moment beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all typical problems for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.
During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a mentor, stopped by with her own five kids in tow to deliver baked goods. They all crowded near 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 dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her knee for the young ones to see and they are crowding near, admiring and touching to the baby.
Jacob, eight, asked the moms: “What about the fathers?” 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’m going to be the best dad ever. They will know they are valued.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could be a mom.”
Tools for treating babies with exposure have existed for decades.
The Finnegan NAS scale was developed in 1975|