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 visited the medical facility after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a companion's property. She was also addicted to fentanyl.

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

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had a month remaining to figure out how to get clean and have this baby.

The medical professional intervened. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

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

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.

After five days, on the 12th of November, Stephanie had a infant weighing a small weight – born before term, small but alive.

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

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

Stephanie had sought recovery multiple times while expecting, and felt awful 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 affection for her child would make her recover only led to greater shame and self-abuse, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The infant was moved to the NICU. When Stephanie at last met her, she was attached to tubes and leads, so tiny she thought she would break her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

Two days later she decided to name her baby Izzie, after the professional who provided support to her.

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

In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a small, growing network of centers like the care home is showing an important truth: when families are kept intact, results get better, custody cases decrease and overall savings increase.

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, a couple of employees came to bring her to the facility.

She departed the institution still in recovery, fearful and unsure about what would come next.

At the care center, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could enter and take her baby away.

For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about survival. Substances came first; reliance came last.

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

Daily, staff from Maddie’s Place drove her to a clinic for methadone, provided orally. Slowly, she was beginning recovery.

She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, 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, visited with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She holds a picture of the moment. She is wearing black pants and a hoodie, a gray knit hat with a bobble on her head, sitting on the wooden floor with the exit nearby. She is slender. Her posture is humble so you do not see her expression. She is holding Izzie up on her leg for the young ones to see and they are gathered around, showing interest to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The parents responded 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 Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could be a mom.”

Tools for treating drug-exposed newborns have existed for decades.

The Finnegan NAS scale was established in 1975|