🔗 Share this article

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, cut off from her relatives, she lived in a shed she had constructed in a companion's property. She was also hooked on fentanyl.

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

Stephanie finally broke down. “I need to leave. 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 was compelled to leave to get high again. She thought she still had several weeks to figure out how to get clean and give birth.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the leg infection was critical, 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 every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

After five days, on the 12th of November, Stephanie gave birth to a baby girl weighing just over four pounds – early, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was detached. Her epidural had failed, her last dose of fentanyl had been given 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 was unsuccessful. She felt without value, blaming herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

“However, I failed,” she said. “I required assistance.”

The pervasive expectation that her affection for her child would make her stop using only led to deeper self-loathing and self-harm, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to give her child the name Izzie, after the nurse who had been so kind to her.

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

In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like the care home is proving a simple point: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to bring her to the facility.

She departed the institution still in withdrawal, scared and uncertain about what would happen next.

---

At the care center, Stephanie still feared that CPS would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could enter 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 was suspicious at that point.”

Life on the streets, she said, was about getting by. Drugs came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She was unable to value herself, let alone anyone else.

Daily, staff from the facility transported her to a recovery program, administered in pill form. Over time, she was beginning recovery.

She utilized each moment 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 pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an professional – all frequent conditions for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.

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. An advocate, a mentor, stopped by with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

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 door behind her. She is lean. Her posture is humble so you do not see her expression. She is lifting the baby on her leg for the young ones to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the mothers: “Why are there no men?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there given the chance.

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

Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could parent.”

---

Approaches for managing drug-exposed newborns have been available for years.

The evaluation method was developed in 1975|