Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell visited the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before coming to the ER 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 give birth.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“I will go,” 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 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.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
Five days later, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – born before term, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her last dose of fentanyl had been administered four hours before delivery.
She felt ill. Ill-equipped for parenting. Undeserving.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she was unsuccessful. She felt without value, blaming herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her source refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I needed help.”
The widespread belief that her affection for her child would make her quit only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was hooked up to monitors, so small 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 continued to doubt she wanted to be her mother.
Following a brief period she decided to call her daughter the same as her nurse, after the attendant who showed compassion 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 cared for jointly, not apart.
In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a developing system of centers like the care home is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to pick her up.
She departed the institution still in withdrawal, scared and uncertain about what would come next.
At the care center, Stephanie still was concerned that CPS would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could arrive and separate them.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Substances came first; faith came last.
Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to let her down. She was unable to love herself, not to mention anyone else.
Each day, staff from the center took her to a recovery program, given as medication. Over time, she was beginning recovery.
She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. A support specialist, a recovery coach, visited with her own children in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She keeps a photo of the moment. She is clad in casual attire, a cap with a pompom on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is lifting the baby 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 mothers: “Where are all the dads?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could be a mom.”
Approaches for managing babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
