🔗 Share this article

Eight months pregnant and in severe pain, Stephanie Rosell arrived at the ER 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 constructed in a companion's property. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and vomited.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had just enough time to get treated before she had to return to use once more. She thought she still had several weeks to figure out how to get clean and give birth.

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

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the leg infection was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.

After five days, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – early, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.

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

Stephanie had sought recovery multiple times while expecting, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her source would not provide to her when she became visibly pregnant.

“However, I failed,” she said. “I required assistance.”

The widespread belief that her bond with her newborn would make her recover only led to deeper self-loathing 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 long-term illness.

The baby was taken to the NICU. When Stephanie at last met her, she was attached to tubes and leads, so small she thought she would hurt her. Cradling her initially, 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.

Following a brief period she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In many parts of America, where a baby is identified with newborn addiction symptoms frequently, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to collect her.

She stepped out of the hospital still in detox, anxious and doubtful about what would follow.

---

At Maddie’s Place, Stephanie still was concerned that authorities would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could enter and separate them.

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

Homelessness, she said, was about getting by. Substances came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to hurt her. She did not know how to love herself, not to mention anyone else.

Each day, staff from Maddie’s Place transported her to a treatment center, given as medication. Slowly, she was embracing sobriety.

She utilized each moment 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 obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an professional – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I could parent.

During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own children in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She has an image of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a pompom on her head, seated on the ground with the entryway at her back. She is lean. Her face is downcast so you miss her features. She is presenting her daughter on her lap for the young ones to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the dads were busy, called away to other tasks, 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 the specialist looked at each other. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could parent.”

---

Methods to address infants affected by substances have been available for years.

The assessment tool was developed in 1975|