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Pregnant and experiencing intense discomfort, Stephanie Rosell visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”

She had used fentanyl before seeking medical help and had just enough time to get treated before she had to return to relapse. She thought she still had a month remaining to find a way to become sober and deliver her child.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, 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 symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

After five days, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – born before term, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been given four hours before delivery.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had sought recovery multiple times while expecting, and felt awful each time she failed. She felt without value, berating herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her source declined to supply to her when she became obviously with child.

“Yet I was unable,” she said. “I required assistance.”

The pervasive expectation that her affection for her child would make her recover only led to greater shame and negative self-talk, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

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

Hospital staff told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, results get better, custody cases decrease 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, care providers came to pick her up.

She left the medical center still in detox, anxious and doubtful about what would happen next.

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At the care center, Stephanie still was concerned that authorities would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and take her baby away.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to let her down. She was unable to care for herself, let alone anyone else.

Daily, staff from the facility transported her to a treatment center, administered in pill form. Slowly, she was starting to get clean.

She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an professional – all typical problems for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. An advocate, a recovery coach, came over with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her posture is humble so you do not see her expression. She is lifting the baby on her leg for the children to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there if they could.

“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could be a mom.”

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

The Finnegan NAS scale was established in 1975|