She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.

Eight months pregnant and in severe pain, Stephanie Rosell arrived at the ER after her infection worsened up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had built in a companion's property. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and vomited.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”

She had consumed opioids before coming to the ER and had just enough time to get treated before she had to return to use once more. She thought she still had a month remaining to figure out how to get clean and have this baby.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie regulated amounts 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 frequently utilized in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing a small weight – premature, tiny yet healthy.

When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was detached. Her pain relief did not work, her final administration of fentanyl had been administered shortly before she gave birth.

She felt sick. Not ready for motherhood. Not fit.

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she relapsed. She felt worthless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her source would not provide to her when she became obviously with child.

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

The widespread belief that her bond with her newborn would make her recover only led to increased guilt and negative self-talk, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the NICU. When Stephanie at last met her, she was connected to monitors, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She continued to doubt 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.

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

In much of the US, where a baby is identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a developing system of centers like this facility is demonstrating a key fact: when parents and infants remain united, recovery succeeds, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she finally did. After confirming she would be a good fit for the program, care providers came to collect her.

She stepped out of the hospital still in withdrawal, scared and uncertain about what would happen next.

At the facility, Stephanie still was concerned that authorities would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could arrive and take her baby away.

For the beginning period, Stephanie kept to herself. “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; faith came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to hurt her. She was unable to value herself, much less anyone else.

Every day, staff from the facility took her to a clinic for methadone, administered in pill form. Slowly, she was embracing sobriety.

She devoted all her time when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a mentor, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is clad in casual attire, a gray knit hat with a bobble on her head, sitting on the wooden floor with the door behind her. She is thin. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her lap for the children 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 dads were busy, called away to other tasks, that they would be there if possible.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I would become a mother.”

Methods to address drug-exposed newborns have been available for years.

The assessment tool was developed in 1975|