A Pregnant Woman's Battle with Fentanyl Addiction: Choosing Motherhood Rescued Both Lives.

In her eighth month of pregnancy and suffering, Stephanie Rosell went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and threw up.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had several weeks to find a way to become sober and give birth.

The medical professional intervened. 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 doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie gave birth to a daughter weighing just over four pounds – early, small but alive.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her epidural had failed, her final administration of fentanyl had been provided four hours before delivery.

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

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

“Yet I was unable,” she said. “I needed help.”

The common assumption that her love for her baby would make her recover only led to deeper self-loathing and self-abuse, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.

The infant was moved to the NICU. When Stephanie at last met her, she was connected to tubes and leads, so tiny she thought she would hurt her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

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

Nurses and doctors told her about a specialized facility, a innovative treatment home where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like the care home is demonstrating a key fact: when families are kept intact, 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 verifying her eligibility for the program, care providers came to bring her to the facility.

She stepped out of the hospital still in withdrawal, anxious and doubtful about what would come next.

At the care center, Stephanie still was concerned that child services would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could walk in and remove her child.

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

Homelessness, she said, was about enduring. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to cause pain. She lacked the ability to love herself, not to mention anyone else.

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

She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I was capable. I could be a mom.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She keeps a photo of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a bobble on her head, seated on the ground with the exit nearby. She is thin. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are gathered around, showing interest to the baby.

One child, eight, asked the parents: “Why are there no men?” The parents responded that the men were occupied, called away to other tasks, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could be a mom.”

Tools for treating infants affected by substances have existed for decades.

The Finnegan NAS scale was established in 1975|