Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.

Eight months pregnant and in severe pain, Stephanie Rosell went to the hospital emergency room 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 friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to figure out how to get clean and have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, 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 at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.

Five days later, on 12 November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – early, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.

She felt unwell. Ill-equipped for parenting. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she failed. She felt worthless, berating herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her dealer declined to supply to her when she became clearly expecting.

“Yet I was unable,” she said. “I had to seek support.”

The pervasive expectation that her love for her baby would make her quit only led to greater shame and negative self-talk, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was hooked up to monitors, so little she thought she would break her. Holding her for the first time, she felt empty. “I just stared 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 the same as her nurse, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like the care home is showing an important truth: when mothers and babies stay together, recovery succeeds, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to bring her to the facility.

She stepped out of the hospital still in recovery, fearful and unsure about what would follow.

At Maddie’s Place, Stephanie still worried that CPS would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any point, someone could walk in and remove her child.

For the first two weeks, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about enduring. Addiction came first; reliance came last.

Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to cause pain. She did not know how to value herself, let alone anyone else.

Every day, staff from the facility took her to a recovery program, 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 sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an professional – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a mentor, came over with her own children in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She holds a picture of the moment. She is wearing casual attire, a gray knit hat with a decoration on her head, seated on the ground with the exit nearby. She is thin. Her head is tilted forward so you cannot see her face. She is lifting the baby on her knee for the children to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if they could.

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could be a mom.”

Methods to address babies with exposure have been available for years.

The evaluation method was established in 1975|