She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Rescued Both Lives.

In her eighth month of pregnancy and suffering, Stephanie Rosell went to the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had built in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”

She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had several weeks to plan her recovery and give birth.

The nurse had other ideas. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

A short time later, on the 12th of November, Stephanie delivered a daughter weighing 4lb 8oz – born before term, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been provided four hours before delivery.

She felt ill. Not ready for motherhood. Undeserving.

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she relapsed. She felt without value, berating herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her supplier refused to sell to her when she became visibly pregnant.

“Yet I was unable,” she said. “I had to seek support.”

The common assumption that her love for her baby would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the special care nursery. When Stephanie at last met her, she was attached to tubes and leads, so tiny she thought she would harm her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to name her baby after her caregiver, after the attendant who showed compassion to her.

Nurses and doctors told her about a care center, a unique recovery environment where women and their babies are supported as a unit, not apart.

In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, foster placements fall and overall savings increase.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to bring her to the facility.

She departed the institution still in withdrawal, anxious and doubtful about what would come next.

At the care center, Stephanie still was concerned that CPS would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could walk in and remove her child.

For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about getting by. Substances came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She did not know how to value herself, let alone anyone else.

Each day, staff from the center transported her to a treatment center, administered in pill form. Gradually, she was embracing sobriety.

She spent every minute 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 intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an professional – all typical problems for babies affected by withdrawal.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. A support specialist, a mentor, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the tiny infant 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 has an image of the moment. She is wearing casual attire, a cap with a bobble on her head, seated on the ground with the entryway at her back. She is slender. Her head is tilted forward so you do not see her expression. She is lifting the baby on her lap for the children to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the parents: “Where are all the dads?” The parents responded that the dads were busy, called away to other tasks, that they would be there if they could.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could parent.”

Methods to address drug-exposed newborns have been used for a long time.

The assessment tool was created in 1975|