🔗 Share this article

In her eighth month of pregnancy and suffering, Stephanie Rosell visited the hospital emergency room 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 built in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before seeking medical help and had only a brief window to get treated before she needed to go home to use once more. She thought she still had a month remaining to figure out how to get clean and deliver her child.

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

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, 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 face grave danger.

She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.

After five days, on a day in November 2022, Stephanie had a infant weighing just over four pounds – born before term, small but alive.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been provided four hours before delivery.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she relapsed. She felt without value, blaming herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her source declined to supply to her when she became visibly pregnant.

“Yet I was unable,” she said. “I needed help.”

The widespread belief that her bond with her newborn would make her stop using only led to deeper self-loathing and self-harm, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.

The newborn was transferred to the NICU. When Stephanie at last met her, she was attached to tubes and leads, so tiny she thought she would hurt her. Holding her for the first time, she felt detached. “I looked 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 call her daughter the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face custody evaluations. 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, fewer children enter care and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to collect her.

She stepped out of the hospital still in recovery, scared and uncertain about what would come next.

---

At Maddie’s Place, Stephanie still was concerned that authorities would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and remove her child.

For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”

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

Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to let her down. She was unable to care for herself, not to mention anyone else.

Daily, staff from the center transported her to a recovery program, provided orally. Slowly, she was starting to get clean.

She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies affected by withdrawal.

When a child recognizes these infants need affection, then I was capable. I could parent.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed 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. Such issues were irrelevant.”

She has an image of the moment. She is dressed in casual attire, a beanie with a pompom on her head, sitting on the wooden floor with the exit nearby. She is lean. 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 gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could be a mom.”

---

Methods to address babies with exposure have been available for years.

The evaluation method was created in 1975|