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

Eight months pregnant and in severe pain, Stephanie Rosell went to the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had built in a companion's property. She was also hooked on fentanyl.

As doctors treated her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”

She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had a month remaining to figure out how to get clean 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 doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

After five days, on the 12th of November, Stephanie had a daughter weighing 4lb 8oz – born before term, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been given a few hours prior to birth.

She felt unwell. Unprepared to be a mother. Not fit.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she failed. She felt worthless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her supplier declined to supply to her when she became visibly pregnant.

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

The widespread belief that her affection for her child would make her recover only led to greater shame and self-abuse, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to monitors, so little she thought she would break her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to name her baby after her caregiver, after the attendant who showed compassion to her.

Hospital staff told her about a care center, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like the care home is demonstrating a key fact: when parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to collect her.

She departed the institution still in detox, scared and uncertain about what would follow.

At Maddie’s Place, Stephanie still was concerned that child services would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could enter and separate them.

For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about getting by. Addiction came first; reliance came last.

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to let her down. She did not know how to value herself, much less anyone else.

Every day, staff from Maddie’s Place drove her to a clinic for methadone, provided orally. Over time, she was beginning recovery.

She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie sat in the visitation area, 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 bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She holds a picture of the moment. She is wearing casual attire, a gray knit hat with a pompom on her head, resting on the floor with the door behind her. She is lean. Her face is downcast so you do not see her expression. She is holding Izzie up on her leg for the young ones to see and they are crowding near, fawning and reaching out to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, called away to other tasks, 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 broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I could be a mom.”

Approaches for managing drug-exposed newborns have been used for a long time.

The assessment tool was developed in 1975|