🔗 Share this article

In her eighth month of pregnancy and suffering, Stephanie Rosell visited the ER after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had several weeks to find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

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

Izzie persuaded the doctor to give Stephanie measured quantities 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 drug that alleviates cravings and is frequently utilized in substance abuse treatment.

A short time later, on a day in November 2022, Stephanie delivered a infant weighing just over four pounds – early, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her pain relief did not work, her final administration of fentanyl had been administered four hours before delivery.

She felt ill. Ill-equipped for parenting. Not fit.

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she failed. She felt hopeless, berating herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her source would not provide to her when she became clearly expecting.

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

The pervasive expectation that her love for her baby would make her quit only led to increased guilt and negative self-talk, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was attached to medical equipment, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to give her child the name the same as her nurse, after the nurse who had been so kind to her.

Nurses and doctors told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like this facility is showing an important truth: when parents and infants remain united, recovery succeeds, foster placements fall and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to collect her.

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

---

At the care center, Stephanie still feared that child services would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could arrive and separate them.

For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about survival. Drugs came first; reliance came last.

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She lacked the ability to love herself, much less anyone else.

Daily, staff from the facility transported her to a recovery program, given as medication. Slowly, she was starting to get clean.

She devoted all her time outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all frequent conditions for babies born with NAS.

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

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a mentor, came over with her own family in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She holds a picture of the moment. She is wearing black pants and a hoodie, a beanie with a bobble on her head, sitting on the wooden floor with the exit nearby. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.

Jacob, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there given the chance.

“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could parent.”

---

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

The Finnegan NAS scale was established in 1975|