She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.

In her eighth month of pregnancy and suffering, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and became sick.

Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”

She had taken the drug before coming to the ER and had only a brief window to get treated before she needed to go home to get high again. She thought she still had several weeks to find a way to become sober and deliver her child.

The nurse had other ideas. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.

A short time later, on a day in November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – 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 epidural had failed, her last dose of fentanyl had been given a few hours prior to birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had sought recovery multiple times while expecting, and felt horrible each time she relapsed. She felt hopeless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her supplier declined to supply to her when she became obviously with child.

“But I couldn’t,” she said. “I needed help.”

The common assumption that her love for her baby would make her quit only led to increased guilt and self-abuse, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.

The baby was taken to the NICU. When Stephanie eventually visited her, she was attached to monitors, so little she thought she would harm her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” 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.

Medical personnel told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like the care home is demonstrating a key fact: when parents and infants remain united, recovery succeeds, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength 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 pick her up.

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

At the care center, Stephanie still was concerned that authorities would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could arrive and separate them.

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.”

Life on the streets, she said, was about getting by. Drugs 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, not to mention anyone else.

Each day, staff from Maddie’s Place took her to a clinic for methadone, provided orally. Gradually, she was beginning recovery.

She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I found the strength. I could parent.

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for supervised visits with their babies. An advocate, a peer support specialist, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She has an image of the moment. She is clad in black pants and a hoodie, a cap with a bobble on her head, resting on the floor with the exit nearby. She is thin. Her posture is humble so you miss her features. She is presenting her daughter on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the mothers: “Why are there no men?” The women attempted to clarify 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. I will teach them about love.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could be a mom.”

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

The Finnegan NAS scale was established in 1975|