She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Saved Them Both.

Pregnant and experiencing intense discomfort, Stephanie Rosell went to the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had constructed in a companion's property. She was also dependent on fentanyl.

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

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had consumed opioids before seeking medical help and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had several weeks to figure out how to get clean and give birth.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

A short time later, on 12 November 2022, Stephanie had a daughter weighing 4lb 8oz – premature, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been given four hours before delivery.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to do the impossible. 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 common assumption that her bond with her newborn would make her stop using only led to greater shame and negative self-talk, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to monitors, so small she thought she would hurt her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.

Nurses and doctors told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is proving a simple point: when families are kept intact, results get better, fewer children enter care 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 stepped out of the hospital still in detox, fearful and unsure about what would happen next.

At the facility, Stephanie still feared that CPS would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could arrive and take her baby away.

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

Homelessness, she said, was about getting by. Drugs came first; trust came last.

Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to let her down. She was unable to value herself, much less anyone else.

Every day, staff from the facility took her to a clinic for methadone, provided orally. Gradually, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an specialist – all typical problems for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a peer support specialist, came over with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in black pants and a hoodie, a beanie with a decoration on her head, resting on the floor with the exit nearby. She is slender. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her knee for the children to see and they are gathered around, fawning and reaching out to the baby.

A young boy, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could parent.”

Approaches for managing babies with exposure have been used for a long time.

The evaluation method was created in 1975|