She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.

Eight months pregnant and in severe pain, Stephanie Rosell arrived at the ER after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had constructed in a friend’s yard. She was also addicted to fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and vomited.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had just enough time to get treated before she needed to go home to get high again. She thought she still had four weeks left to plan her recovery and deliver her child.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.

Five days later, on the 12th of November, Stephanie delivered a daughter weighing 4lb 8oz – born before term, tiny yet healthy.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been provided a few hours prior to birth.

She felt ill. Unprepared to be a mother. Unworthy.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she failed. She felt without value, berating herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her supplier refused to sell to her when she became visibly pregnant.

“However, I failed,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her recover only led to greater shame and self-harm, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was attached to monitors, so little 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 continued to doubt she wanted to be her mother.

Two days later she decided to call her daughter Izzie, after the nurse who had been so kind to her.

Hospital staff told her about a specialized facility, a unique recovery environment 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 frequently, infants are still rushed to special care and treated with pharmaceuticals 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, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to collect her.

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

At the care center, Stephanie still feared that child services would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could arrive and separate them.

For the beginning period, Stephanie kept to herself. “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. Drugs came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to let her down. She did not know how to value herself, much less anyone else.

Daily, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Slowly, she was embracing sobriety.

She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an specialist – all frequent conditions for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, came over with her own children in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is clad in black pants and a hoodie, a cap with a decoration on her head, sitting on the wooden floor with the door behind her. She is thin. Her head is tilted forward so you cannot see her face. She is lifting the baby on her leg for the other kids to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could be a mom.”

Methods to address infants affected by substances have been available for years.

The evaluation method was developed in 1975|