She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Saved Them Both.

Eight months pregnant and in severe pain, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and became sick.

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

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 four weeks left to figure out how to get clean and deliver her child.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, 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 be at risk of death.

She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie delivered a infant weighing just over four pounds – early, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered shortly before she gave birth.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she relapsed. She felt hopeless, blaming herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her dealer declined to supply to her when she became obviously with child.

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

The widespread belief that her love for her baby would make her stop using only led to greater shame and self-harm, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.

The baby was taken to the NICU. When Stephanie finally saw her her, she was connected to monitors, so small she thought she would harm her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure 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 Maddie’s Place, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a small, growing network of centers like the care home is proving a simple point: when parents and infants remain united, results get better, fewer children enter care and overall savings increase.

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, care providers came to collect her.

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

At the care center, Stephanie still feared that authorities would come take Izzie – 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 kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about survival. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to cause pain. She did not know how to value herself, not to mention anyone else.

Every day, staff from the center took her to a recovery program, provided orally. Over time, she was starting to get clean.

She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an professional – all frequent conditions for babies born with NAS.

Seeing that even a young person understands the need for care, then I found the strength. I could parent.

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. A support specialist, a mentor, stopped by with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The young ones stared in wonder of the little newborn in Stephanie’s arms. “They were innocent,” 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 casual attire, a cap with a pompom on her head, sitting on the wooden floor with the exit nearby. She is slender. Her head is tilted forward so you cannot see her face. She is lifting the baby on her leg for the other kids to see and they are crowding near, admiring and touching to the baby.

Jacob, eight, asked the moms: “Where are all the dads?” The women attempted to clarify 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. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could be a mom.”

Approaches for managing infants affected by substances have been available for years.

The assessment tool was established in 1975|