She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Saved Them Both.

In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the medical facility after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had built in a friend’s yard. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie eventually collapsed. “I have to get out of here. 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 was compelled to leave to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection 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.

She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

After five days, on a day in November 2022, Stephanie had a infant weighing just over four pounds – early, small but alive.

When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.

She felt sick. Unprepared to be a mother. Unworthy.

Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she relapsed. She felt without value, blaming herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her dealer would not provide to her when she became clearly expecting.

“However, I failed,” she said. “I needed help.”

The widespread belief that her bond with her newborn would make her stop using only led to increased guilt and negative self-talk, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.

The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was attached to monitors, so small she thought she would harm her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

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

Nurses and doctors told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when parents and infants remain united, outcomes improve, foster placements fall and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to pick her up.

She left the medical center still in detox, fearful and unsure about what would come next.

At the care center, Stephanie still worried that authorities 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 enter and remove her child.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

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

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She was unable to love herself, let alone anyone else.

Each day, staff from the facility drove her to a clinic for methadone, given as medication. Slowly, she was beginning recovery.

She utilized each moment beyond therapy 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 nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all common issues for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed 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. They focused only on the baby.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is slender. Her posture is humble so you miss her features. She is presenting her daughter on her knee for the young ones to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the moms: “Why are there no men?” The parents responded that the men were occupied, called away to other tasks, that they would be there if possible.

“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could parent.”

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

The assessment tool was established in 1975|