🔗 Share this article

Eight months pregnant and in severe pain, Stephanie Rosell arrived at the hospital emergency room after her infection worsened 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 dependent on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and threw up.

Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had sufficient opportunity 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 give birth.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.

After five days, on the 12th of November, Stephanie delivered a daughter weighing 4lb 8oz – premature, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been administered a few hours prior to birth.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had sought recovery several times during pregnancy, and felt terrible each time she failed. She felt worthless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her dealer refused to sell to her when she became obviously with child.

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

The common assumption that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was connected to monitors, so small she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

After two days she decided to give her child the name 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 much of the US, where a baby is identified with infant withdrawal condition regularly, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength 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, 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 concern persisted: that at any moment, someone could enter and take her baby away.

For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about survival. Substances came first; trust came last.

Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to let her down. She did not know how to value herself, let alone anyone else.

Each day, staff from the center took her to a recovery program, 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 receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an specialist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I could be a mom.

One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a recovery coach, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She has an image of the moment. She is dressed in black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is lean. Her head is tilted forward so you do not see her expression. She is lifting the baby on her lap for the children to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the men were occupied, called away to other tasks, that they would be there if possible.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could parent.”

---

Tools for treating infants affected by substances have existed for decades.

The assessment tool was established in 1975|