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In her eighth month of pregnancy and suffering, Stephanie Rosell visited the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and became sick.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had several weeks to find a way to become sober and give birth.

The nurse had other ideas. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was critical, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.

A short time later, on a day in November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been administered four hours before delivery.

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

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she failed. She felt hopeless, berating herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The common assumption that her bond with her newborn would make her quit only led to deeper self-loathing and negative self-talk, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the special care nursery. When Stephanie at last met her, she was connected to monitors, so tiny she thought she would harm her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

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

Nurses and doctors told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when families are kept intact, recovery succeeds, custody cases decrease and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to pick her up.

She departed the institution still in detox, anxious and doubtful about what would follow.

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At the facility, Stephanie still feared that CPS would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could enter and remove her child.

For the first two weeks, Stephanie remained isolated. “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 getting by. Drugs came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She lacked the ability to love herself, let alone anyone else.

Daily, staff from the center transported her to a recovery program, administered in pill form. Over time, she was embracing sobriety.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an professional – all typical problems for babies born with NAS.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. A support specialist, a mentor, came over with her own five kids in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She has an image of the moment. She is wearing black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is slender. Her posture is humble 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.

Jacob, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if they could.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I found the courage. I could be a mom.”

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

The assessment tool was developed in 1975|