Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.

In her eighth month of pregnancy and suffering, Stephanie Rosell visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had built in a companion's property. She was also hooked on fentanyl.

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

Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”

She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to plan her recovery and deliver her child.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“Yes, I am,” 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 amniotic fluid leak. 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. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.

A short time later, on a day in November 2022, Stephanie had a daughter weighing 4lb 8oz – early, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been provided shortly before she gave birth.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her source declined to supply to her when she became visibly pregnant.

“Yet I was unable,” she said. “I needed help.”

The widespread belief that her love for her baby would make her recover only led to increased guilt 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 persistent condition.

The newborn was transferred to the NICU. When Stephanie finally saw her her, she was hooked up to medical equipment, so tiny she thought she would harm her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Two days later she decided to give her child the name Izzie, after the professional who provided support to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In numerous states, where a baby is identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like this facility is demonstrating a key fact: when parents and infants remain united, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to pick her up.

She left the medical center still in recovery, anxious and doubtful about what would follow.

At Maddie’s Place, Stephanie still was concerned that authorities would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could walk in and take her baby away.

For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about enduring. Drugs came first; reliance came last.

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to care for herself, much less anyone else.

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

She spent every minute when not in sessions 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 feeding therapy. She also had sensory challenges and required an occupational therapist – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I could do this. I could parent.

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. An advocate, a recovery coach, stopped by with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, resting on the floor with the door behind her. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up 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: “Why are there no men?” The parents responded that the men were occupied, handling responsibilities, that they would be there given the chance.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and the specialist exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I would become a mother.”

Methods to address infants affected by substances have been available for years.

The assessment tool was developed in 1975|