🔗 Share this article

Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at 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 built in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”

She had used fentanyl before seeking medical help and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to figure out how to get clean and have this baby.

The attending nurse disagreed. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

A short time later, on the 12th of November, Stephanie delivered a baby girl weighing a small weight – born before term, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been administered four hours before delivery.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she was unsuccessful. She felt without value, criticizing herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her source refused to sell to her when she became obviously with child.

“However, I failed,” she said. “I had to seek support.”

The widespread belief that her affection for her child would make her recover only led to deeper self-loathing and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was attached to tubes and leads, so little she thought she would hurt her. Embracing her at last, she felt detached. “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 the same as her nurse, after the nurse who had been so kind to her.

Medical personnel told her about a care center, a innovative treatment home where women and their babies are treated together, not apart.

In much of the US, where a baby is identified with newborn addiction symptoms regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is proving a simple point: when mothers and babies stay together, recovery succeeds, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

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

---

At the facility, Stephanie still worried that child services would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could walk in and take her baby away.

For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about getting by. Drugs came first; reliance 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 lacked the ability to love herself, not to mention anyone else.

Each day, staff from the center took her to a recovery program, administered in pill form. Gradually, she was beginning recovery.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all common issues for babies exposed to substances.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a peer support specialist, visited with her own five kids in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in awe of the small baby in Stephanie’s arms. “They were innocent,” 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 beanie with a pompom on her head, resting on the floor with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is holding Izzie up on her leg for the young ones to see and they are gathered around, admiring and touching to the baby.

One child, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there if they could.

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

Stephanie and Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I would become a mother.”

---

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

The evaluation method was developed in 1975|