🔗 Share this article

In her eighth month of pregnancy and suffering, Stephanie Rosell went to the ER after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had constructed in a friend’s yard. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

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 only a brief window to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and deliver her child.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection was serious, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

After five days, on the 12th of November, Stephanie gave birth to a baby girl weighing a small weight – early, small but alive.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.

She felt sick. Not ready for motherhood. Not fit.

Stephanie had sought recovery several times during pregnancy, and felt awful each time she was unsuccessful. She felt worthless, berating herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her dealer would not provide to her when she became obviously with child.

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

The common assumption that her bond with her newborn would make her quit only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the NICU. When Stephanie at last met her, she was connected to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to name her baby after her caregiver, after the attendant who showed compassion to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where women and their babies are cared for jointly, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, recovery succeeds, foster placements fall and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, two staff members came to pick her up.

She departed the institution still in withdrawal, scared and uncertain about what would follow.

---

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

For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

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

Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to hurt her. She did not know how to care for herself, much less anyone else.

Each day, staff from the center took her to a recovery program, provided orally. Over time, she was beginning recovery.

She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I was capable. I could be a mom.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a cap with a pompom on her head, resting on the floor with the exit nearby. She is lean. Her posture is humble so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are gathered around, admiring and touching to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there if they could.

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

Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I would become a mother.”

---

Approaches for managing drug-exposed newborns have existed for decades.

The evaluation method was developed in 1975|