She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.

In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the medical facility after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”

She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to find a way to become sober and deliver her child.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was critical, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.

After five days, on 12 November 2022, Stephanie delivered a daughter weighing a small weight – premature, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been administered shortly before she gave birth.

She felt sick. Unprepared to be a mother. 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 do the impossible. An obstetrician told her to “just” stop using. Even her supplier would not provide to her when she became obviously with child.

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

The pervasive expectation that her love for her baby would make her quit only led to increased guilt and negative self-talk, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The infant was moved to the NICU. When Stephanie eventually visited her, she was connected to monitors, so little she thought she would break her. Cradling her initially, she felt nothing. “I just stared 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 give her child the name after her caregiver, after the nurse who had been so kind to her.

Nurses and doctors 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 found to have infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is proving a simple point: when families are kept intact, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, two staff members 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 feared that CPS would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could walk in and remove her child.

For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about enduring. Substances came first; reliance came last.

Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to cause pain. She was unable to care for herself, much less anyone else.

Every day, staff from the center drove her to a treatment center, given as medication. Gradually, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an specialist – all typical problems for babies born with NAS.

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. A support specialist, a mentor, came over with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She holds a picture of the moment. She is clad in black pants and a hoodie, a beanie with a decoration on her head, seated on the ground with the exit nearby. She is thin. Her posture is humble so you cannot see her face. She is presenting her daughter on her knee for the other kids to see and they are crowding near, fawning and reaching out to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.”

Approaches for managing drug-exposed newborns have been available for years.

The Finnegan NAS scale was established in 1975|