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Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the hospital emergency room after an infection began spreading up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had assembled in a friend’s yard. She was also addicted to fentanyl.

As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and threw up.

Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”

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

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was critical, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie had a infant weighing a small weight – born before term, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been given shortly before she gave birth.

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

Stephanie had sought recovery repeatedly before birth, and felt horrible each time she relapsed. She felt worthless, blaming herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her source would not provide to her when she became visibly pregnant.

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

The common assumption that her affection for her child would make her stop using only led to greater shame and self-abuse, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the special care nursery. When Stephanie at last met her, she was connected to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt detached. “I just stared 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 Izzie, after the nurse who had been so kind to her.

Nurses and doctors told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.

In numerous states, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is showing an important truth: when mothers and babies stay together, results get better, foster placements fall and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to collect her.

She left the medical center still in withdrawal, scared and uncertain about what would come next.

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At the facility, Stephanie still was concerned that child services would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and remove her child.

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. Drugs came first; reliance came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to care for herself, much less anyone else.

Every day, staff from the facility took her to a treatment center, administered in pill form. Over time, she was starting to get clean.

She utilized each moment beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an specialist – 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.

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. An advocate, a mentor, visited with her own children 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 little newborn 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 keeps a photo of the moment. She is dressed in black pants and a hoodie, a beanie with a pompom on her head, resting on the floor with the door behind her. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her leg for the children to see and they are gathered around, admiring and touching to the baby.

A young boy, eight, asked the mothers: “What about the fathers?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if possible.

“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could parent.”

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Methods to address infants affected by substances have existed for decades.

The assessment tool was developed in 1975|