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

In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital and had only a brief window 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 give birth.

The medical professional intervened. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was critical, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.

Five days later, on the 12th of November, Stephanie had a infant weighing 4lb 8oz – born before term, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been given shortly before she gave birth.

She felt sick. Ill-equipped for parenting. Unworthy.

Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she failed. She felt without value, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her source would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her quit only led to greater shame and self-abuse, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was connected to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to call her daughter after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about a care center, a unique recovery environment where women and their babies are treated together, not apart.

In numerous states, where a baby is found to have infant withdrawal condition frequently, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a small, growing network of centers like this facility is showing an important truth: when mothers and babies stay together, outcomes improve, custody cases decrease and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to collect her.

She departed the institution still in recovery, fearful and unsure about what would follow.

At the facility, Stephanie still feared that child services would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could enter and remove her child.

For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about getting by. Addiction came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The people she loved always found ways to cause pain. She did not know how to love herself, not to mention anyone else.

Each day, staff from Maddie’s Place drove her to a recovery program, administered in pill form. Gradually, she was beginning recovery.

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 severe digestive problems. She needed dietary support. She also had sensory challenges 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 could do this. I could be a mom.

On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. An advocate, a recovery coach, stopped by with her own children in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” 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 dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, seated on the ground with the door behind her. She is thin. Her posture is humble so you miss her features. She is presenting her daughter on her leg for the young ones to see and they are standing close, showing interest to the baby.

One child, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I would become a mother.”

Methods to address infants affected by substances have existed for decades.

The Finnegan NAS scale was established in 1975|