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In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the hospital emergency room after her infection worsened up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and vomited.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to use once more. 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 staying put.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.

Five days later, on the 12th of November, Stephanie had a daughter weighing a small weight – born before term, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been provided four hours before delivery.

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

Stephanie had sought recovery several times during pregnancy, and felt awful each time she was unsuccessful. She felt worthless, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her source declined to supply to her when she became visibly pregnant.

“But I couldn’t,” she said. “I required assistance.”

The pervasive expectation that her love for her baby would make her quit only led to deeper self-loathing and negative self-talk, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was attached to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter Izzie, after the professional who provided support to her.

Medical personnel told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is showing an important truth: when families are kept intact, results get better, custody cases decrease and future expenses reduce.

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 pick her up.

She departed the institution still in recovery, anxious and doubtful about what would come next.

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At Maddie’s Place, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could walk in and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about survival. Substances came first; reliance came last.

Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to hurt her. She was unable to love herself, not to mention anyone else.

Every day, staff from the center drove her to a recovery program, provided orally. Gradually, she was embracing sobriety.

She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies born with NAS.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a recovery coach, visited with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She keeps a photo of the moment. She is dressed in black pants and a hoodie, a beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is presenting her daughter on her leg for the young ones to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there if possible.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I would become a mother.”

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Tools for treating infants affected by substances have been used for a long time.

The Finnegan NAS scale was created in 1975|