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Eight months pregnant and in severe pain, 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 constructed in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and threw up.

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

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she had to return to get high again. She thought she still had a month remaining 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 leg infection was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie measured quantities 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 drug that alleviates cravings and is often prescribed in addiction recovery.

Five days later, on the 12th of November, Stephanie delivered a baby girl weighing 4lb 8oz – early, little but surviving.

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

She felt sick. Not ready for motherhood. Undeserving.

Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she failed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her source refused to sell to her when she became visibly pregnant.

“Yet I was unable,” she said. “I had to seek support.”

The widespread belief that her love for her baby would make her quit only led to greater shame and negative self-talk, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was connected to tubes and leads, so tiny she thought she would harm her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to give her child the name after her caregiver, after the professional who provided support to her.

Hospital staff told her about Maddie’s Place, a innovative treatment home where mothers and their drug-exposed newborns are supported as a unit, not apart.

In many parts of America, 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 parental assessments. But a developing system of centers like the care home is demonstrating a key fact: when parents and infants remain united, results get better, custody cases decrease and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to collect her.

She stepped out of the hospital still in recovery, fearful and unsure about what would happen next.

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At the care center, Stephanie still feared that CPS would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could walk in and take her baby away.

For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” 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 connection was tenuous. The those close to her always found ways to let her down. She did not know how to love herself, not to mention anyone else.

Daily, staff from Maddie’s Place took her to a clinic for methadone, provided orally. Slowly, she was starting to get clean.

She utilized each moment when not in sessions 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 dietary support. She also had heightened sensory issues and required an professional – all frequent conditions 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.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. An advocate, a mentor, came over with her own five kids in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, sitting on the wooden floor with the exit nearby. She is thin. Her posture is humble so you cannot see her face. She is presenting her daughter on her lap for the young ones to see and they are crowding near, showing interest to the baby.

One child, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could parent.”

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Approaches for managing infants affected by substances have been used for a long time.

The Finnegan NAS scale was created in 1975|