Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Pregnant and experiencing intense discomfort, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had constructed in a companion's property. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home to relapse. She thought she still had a month remaining to figure out how to get clean and give birth.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
She encouraged 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 transitioned to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.
A short time later, on the 12th of November, Stephanie gave birth to a infant weighing just over four pounds – born before term, little but surviving.
When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her last dose of fentanyl had been provided shortly before she gave birth.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had sought recovery several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, blaming herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her supplier would not provide to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her recover only led to increased guilt and negative self-talk, a cause for her to relapse. Yet she could not easily command 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 eventually visited her, she was attached to tubes and leads, so tiny she thought she would harm her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to name her baby the same as her nurse, after the professional who provided support to her.
Medical personnel told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.
In much of the US, where a baby is identified with infant withdrawal condition regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like this facility is showing an important truth: when families are kept intact, results get better, foster placements fall and overall savings increase.
It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to pick her up.
She departed the institution still in detox, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still feared that CPS would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could enter and separate them.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Addiction came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to hurt her. She lacked the ability to love herself, let alone anyone else.
Every day, staff from Maddie’s Place transported her to a treatment center, given as medication. Gradually, she was beginning recovery.
She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an professional – all typical problems for babies exposed to substances.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. A support specialist, a recovery coach, visited with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She holds a picture of the moment. She is clad in black pants and a hoodie, a cap with a bobble on her head, seated on the ground with the exit nearby. She is slender. 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 standing close, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if possible.
“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I would become a mother.”
Methods to address infants affected by substances have been used for a long time.
The Finnegan NAS scale was developed in 1975|
