Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.

In her eighth month of pregnancy and suffering, Stephanie Rosell visited the ER after an infection began spreading up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built in a companion's property. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

Stephanie eventually collapsed. “I need to leave. 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 needed to go home to use once more. She thought she still had several weeks to figure out how to get clean and give birth.

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

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, 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 placed on methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.

After five days, on a day in November 2022, Stephanie gave birth to a daughter weighing a small weight – early, small but alive.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been given a few hours prior to birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt without value, berating herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her source would not provide to her when she became obviously with child.

“Yet I was unable,” she said. “I required assistance.”

The common assumption that her affection for her child would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the NICU. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would hurt her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to call her daughter Izzie, after the professional who provided support to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, outcomes improve, foster placements fall and future expenses reduce.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to collect her.

She left the medical center still in withdrawal, scared and uncertain about what would come next.

At Maddie’s Place, Stephanie still feared that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any time, someone could enter and take her baby away.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

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

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to love herself, let alone anyone else.

Daily, staff from Maddie’s Place took her to a treatment center, given as medication. Slowly, she was beginning recovery.

She spent every minute beyond therapy 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 sensory challenges and required an occupational therapist – all common issues for babies born with NAS.

When a child recognizes these infants need affection, then I was capable. I could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own children in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing black pants and a hoodie, a gray knit hat with a decoration on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you cannot see her face. She is holding Izzie up on her leg for the other kids to see and they are gathered around, admiring and touching to the baby.

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

“When I have kids,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.”

Methods to address babies with exposure have been available for years.

The Finnegan NAS scale was established in 1975|