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Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the medical facility after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had constructed in a companion's property. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside 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 seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to figure out how to get clean and have this baby.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was critical, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

A short time later, on 12 November 2022, Stephanie delivered a infant weighing 4lb 8oz – premature, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been provided four hours before delivery.

She felt sick. Ill-equipped for parenting. Undeserving.

Stephanie had sought recovery repeatedly before birth, and felt awful each time she relapsed. She felt hopeless, berating herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her source refused to sell to her when she became clearly expecting.

“However, I failed,” she said. “I needed help.”

The widespread belief that her bond with her newborn would make her stop using only led to increased guilt and negative self-talk, a trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was connected to medical equipment, so little she thought she would break her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to call her daughter the same as her nurse, 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 parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is demonstrating a key fact: when parents and infants remain united, results get better, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She stepped out of the hospital still in recovery, anxious and doubtful about what would come next.

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At the care center, Stephanie still was concerned that CPS would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could arrive and take her baby away.

For the first two weeks, Stephanie kept to herself. “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. Addiction came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The people she loved always found ways to cause pain. She lacked the ability to care for herself, much less anyone else.

Every day, staff from Maddie’s Place took her to a treatment center, provided orally. Gradually, she was starting to get clean.

She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an professional – all common issues for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.

On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a peer support specialist, came over 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 wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a pompom on her head, seated on the ground with the door behind her. She is slender. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her knee for the children to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there given the chance.

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I would become a mother.”

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Approaches for managing drug-exposed newborns have been used for a long time.

The assessment tool was created in 1975|