🔗 Share this article

In her eighth month of pregnancy and suffering, Stephanie Rosell went to 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 assembled in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had a month remaining to find a way to become sober and deliver her child.

The medical professional intervened. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

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

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.

A short time later, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – premature, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been administered shortly before she gave birth.

She felt unwell. Ill-equipped for parenting. Unworthy.

Stephanie had sought recovery multiple times while expecting, and felt horrible each time she relapsed. She felt worthless, blaming herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her supplier would not provide to her when she became visibly pregnant.

“But I couldn’t,” she said. “I needed help.”

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

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to name her baby after her caregiver, after the professional who provided support to her.

Medical personnel told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.

In much of the US, where a baby is identified with newborn addiction symptoms regularly, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like the care home is showing an important truth: when families are kept intact, results get better, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, two staff members came to collect her.

She stepped out of the hospital still in recovery, fearful and unsure about what would happen next.

---

At the facility, Stephanie still feared that CPS would come take Izzie – even though she was hesitant about parenting. The fear lingered: 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.”

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

Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She lacked the ability to care for herself, not to mention anyone else.

Every day, staff from Maddie’s Place took her to a treatment center, given as medication. Over time, she was embracing sobriety.

She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an professional – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I could do this. I could be a mom.

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 peer support specialist, visited with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in wonder of the small baby 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 keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, resting on the floor with the door behind her. She is lean. Her posture is humble so you cannot see her face. She is lifting the baby on her knee for the children to see and they are gathered around, fawning and reaching out to the baby.

A young boy, eight, asked the moms: “Why are there no men?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there given the chance.

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

Stephanie and the specialist exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could parent.”

---

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

The assessment tool was created in 1975|