🔗 Share this article

Pregnant and experiencing intense discomfort, Stephanie Rosell went to the medical facility after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had constructed in a friend’s yard. She was also addicted to fentanyl.

As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and threw up.

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

She had used fentanyl before coming to the ER and had just enough time to get treated before she needed to go home to use once more. She thought she still had four weeks left to plan her recovery and have this baby.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.

After five days, on the 12th of November, Stephanie had a infant weighing just over four pounds – premature, tiny yet healthy.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.

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

Stephanie had sought recovery several times during pregnancy, and felt awful each time she was unsuccessful. She felt without value, blaming herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her dealer refused to sell to her when she became clearly expecting.

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

The pervasive expectation that her affection for her child would make her recover only led to greater shame and self-harm, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was connected to tubes and leads, so tiny she thought she would hurt her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

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

Nurses and doctors told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In many parts of America, where a baby is found to have newborn addiction symptoms frequently, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is proving a simple point: when families are kept intact, results get better, fewer children enter care and overall savings increase.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to collect her.

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

---

At the care center, Stephanie still was concerned that child services 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 separate them.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about getting by. Drugs came first; reliance came last.

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

Daily, staff from the center drove her to a recovery program, given as medication. Gradually, she was beginning recovery.

She devoted all her time outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an professional – all typical problems for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.

On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a peer support specialist, came over with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She keeps a photo of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a bobble on her head, seated on the ground with the entryway at her back. She is lean. Her face is downcast so you cannot see her face. She is holding Izzie up on her lap for the other kids to see and they are crowding near, fawning and reaching out to the baby.

A young boy, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could parent.”

---

Approaches for managing babies with exposure have existed for decades.

The assessment tool was developed in 1975|