She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.

Eight months pregnant and in severe pain, Stephanie Rosell arrived at the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had built in a companion's property. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and became sick.

Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had four weeks left to find a way to become sober and give birth.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

Five days later, on the 12th of November, Stephanie gave birth to a infant weighing a small weight – born before term, tiny yet healthy.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.

She felt sick. Ill-equipped for parenting. Not fit.

Stephanie had sought recovery repeatedly before birth, and felt horrible each time she relapsed. She felt without value, blaming herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her dealer declined to supply to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The common assumption that her affection for her child would make her recover 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 eliminate a long-term illness.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to monitors, so tiny she thought she would hurt her. Cradling her initially, she felt empty. “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 name her baby after her caregiver, after the professional who provided support to her.

Hospital staff told her about a care center, a new kind of care center where women and their babies are treated together, not apart.

In much of the US, where a baby is found to have infant withdrawal condition regularly, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when parents and infants remain united, recovery succeeds, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, care providers came to collect her.

She left the medical center still in withdrawal, fearful and unsure about what would follow.

At Maddie’s Place, Stephanie still was concerned that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could enter and remove her child.

For the initial fortnight, Stephanie stayed withdrawn. “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 enduring. Addiction came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She lacked the ability to love herself, not to mention anyone else.

Each day, staff from Maddie’s Place drove her to a treatment center, provided orally. Over time, she was beginning recovery.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I could do this. I could be a mom.

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, visited with her own family in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

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

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the mothers: “Why are there no men?” The parents responded that the dads were busy, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I would become a mother.”

Approaches for managing babies with exposure have existed for decades.

The Finnegan NAS scale was developed in 1975|