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In her eighth month of pregnancy and suffering, Stephanie Rosell visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also hooked on fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and vomited.

Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she had to return to get high again. She thought she still had a month remaining to find a way to become sober and give birth.

The nurse had other ideas. She told Stephanie she was staying put.

“I will go,” 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, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.

Five days later, on the 12th of November, Stephanie gave birth to a infant weighing a small weight – premature, tiny yet healthy.

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

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

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she relapsed. She felt worthless, criticizing herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

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

The pervasive expectation that her love for her baby would make her stop using only led to increased guilt and self-harm, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was attached to medical equipment, so little she thought she would hurt her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to name her baby Izzie, after the nurse who had been so kind to her.

Hospital staff told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is identified with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a developing system of centers like the care home is showing an important truth: when parents and infants remain united, results get better, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to bring her to the facility.

She left the medical center still in withdrawal, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still was concerned that child services would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could arrive and separate them.

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

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

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to let her down. She was unable to care for herself, much less anyone else.

Each day, staff from the center took her to a clinic for methadone, given as medication. Over time, she was beginning recovery.

She devoted all her time outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an professional – all frequent conditions for babies affected by withdrawal.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own family in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a decoration on her head, resting on the floor with the exit nearby. She is thin. Her posture is humble so you miss her features. She is holding Izzie up on her knee for the young ones to see and they are standing close, fawning and reaching out to the baby.

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

“When I have kids,” Jacob said, “I will excel as a father. 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 infants need affection, then I could do this. I could be a mom.”

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Tools for treating babies with exposure have existed for decades.

The Finnegan NAS scale was established in 1975|