A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Transformed Their Futures.

Eight months pregnant and in severe pain, Stephanie Rosell went to the medical facility after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed 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 coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had several weeks to find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

After five days, on a day in November 2022, Stephanie delivered a infant weighing a small weight – born before term, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been administered a few hours prior to birth.

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

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she failed. She felt worthless, blaming herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her supplier declined to supply to her when she became visibly pregnant.

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

The common assumption that her affection for her child would make her stop using only led to greater shame and self-harm, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.

The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to tubes and leads, so small she thought she would break her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” 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 professional who provided support to her.

Nurses and doctors told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like this facility is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, fewer children enter care and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to bring her to the facility.

She left the medical center still in withdrawal, scared and uncertain about what would come next.

At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and remove her child.

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

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

Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to cause pain. She was unable to value herself, let alone anyone else.

Every day, staff from the center drove her to a treatment center, provided orally. Gradually, she was starting to get clean.

She devoted all her time outside treatment 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 obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own children in tow to bring treats. They all crowded near 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. “My past did not matter to them. They focused only on the baby.”

She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her posture is humble so you do not see her expression. She is lifting the baby 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 mothers: “What about the fathers?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could be a mom.”

Approaches for managing babies with exposure have existed for decades.

The assessment tool was developed in 1975|