Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had constructed in a companion's property. She was also dependent on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and threw up.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”
She had taken the drug 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 have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the infection in her legs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.
Izzie persuaded 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 switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
After five days, on the 12th of November, Stephanie had a baby girl weighing a small weight – premature, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been administered a few hours prior to birth.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt without value, berating herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“However, I failed,” she said. “I required assistance.”
The common assumption that her affection for her child would make her stop using only led to greater shame and self-harm, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a persistent condition.
The infant was moved to the special care nursery. When Stephanie at last met her, she was connected to medical equipment, so small she thought she would hurt her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.
Medical personnel told her about a care center, a unique recovery environment where parents and infants affected by substance use are supported as a unit, 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 medicated while their mothers face parental assessments. But a limited but expanding group of centers like this facility is showing an important truth: when mothers and babies stay together, outcomes improve, foster placements fall and overall savings increase.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to collect her.
She stepped out of the hospital still in withdrawal, scared and uncertain about what would happen next.
At the facility, Stephanie still worried that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about enduring. Addiction came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to cause pain. She did not know how to value herself, let alone anyone else.
Each day, staff from the facility drove her to a clinic for methadone, provided orally. 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 infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges 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 was in the common room, where parents in active addiction can come for supervised visits with their babies. A support specialist, a mentor, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed 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. None of those things mattered to them.”
She keeps a photo of the moment. She is clad in black pants and a hoodie, a gray knit hat with a pompom on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her lap for the other kids to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there if possible.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could parent.”
Approaches for managing infants affected by substances have been used for a long time.
The Finnegan NAS scale was established in 1975|
