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Eight months pregnant and in severe pain, Stephanie Rosell went to the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a acquaintance's garden. She was also dependent on fentanyl.

As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and became sick.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had several weeks to plan her recovery and have this baby.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was severe, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

Five days later, on the 12th of November, Stephanie delivered a infant weighing just over four pounds – premature, tiny yet healthy.

When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her pain relief did not work, her last dose of fentanyl had been administered shortly before she gave birth.

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

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her source declined to supply to her when she became clearly expecting.

“But I couldn’t,” she said. “I needed help.”

The common assumption that her love for her baby would make her recover only led to increased guilt and self-abuse, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could will away a persistent condition.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was connected to monitors, so tiny she thought she would hurt her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name after her caregiver, after the professional who provided support to her.

Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a small, growing network of centers like the care home is proving a simple point: when mothers and babies stay together, results get better, foster placements fall and future expenses reduce.

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 departed the institution still in withdrawal, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still was concerned that authorities would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could enter and take her baby away.

For the beginning period, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about enduring. Addiction came first; faith came last.

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to let her down. 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, provided orally. Over time, she was embracing sobriety.

She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an specialist – all typical problems for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a mentor, came over with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in awe of the tiny infant 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 dressed in casual attire, a cap with a decoration on her head, seated on the ground with the entryway at her back. She is lean. Her posture is humble so you miss her features. She is holding Izzie up on her knee for the children to see and they are crowding near, admiring and touching to the baby.

Jacob, eight, asked the moms: “Why are there no men?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if they could.

“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could be a mom.”

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Approaches for managing drug-exposed newborns have been available for years.

The evaluation method was established in 1975|