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Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also hooked on fentanyl.

As medical staff managed 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 take a hit.”

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had several weeks to figure out how to get clean and deliver her child.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, 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 abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.

After five days, on the 12th of November, Stephanie gave birth to a infant weighing 4lb 8oz – born before term, small but alive.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been provided four hours before delivery.

She felt ill. Unprepared to be a mother. Undeserving.

Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she was unsuccessful. She felt without value, berating herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became obviously with child.

“However, I failed,” she said. “I required assistance.”

The common assumption that her affection for her child would make her quit only led to greater shame and negative self-talk, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was connected to monitors, so small she thought she would harm her. Embracing her at last, she felt empty. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to name her baby after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In much of the US, where a baby is found to have infant withdrawal condition frequently, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like this facility is proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

She stepped out of the hospital still in recovery, scared and uncertain about what would follow.

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At the care center, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could walk in and separate them.

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

Homelessness, she said, was about enduring. Drugs came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She lacked the ability to love herself, not to mention anyone else.

Daily, staff from the facility transported her to a treatment center, provided orally. Slowly, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies born with NAS.

When a child recognizes these infants need affection, then I could do this. I would become a mother.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, visited with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a cap with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her knee for the young ones to see and they are crowding near, admiring and touching to the baby.

A young boy, eight, asked the parents: “What about the fathers?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if possible.

“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”

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

The evaluation method was created in 1975|