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Eight months pregnant and in severe pain, Stephanie Rosell went to the medical facility after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had constructed in a friend’s yard. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to figure out how to get clean and have this baby.

The medical professional intervened. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was serious, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – early, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been administered a few hours prior to birth.

She felt ill. Not ready for motherhood. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt awful each time she failed. She felt worthless, berating herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became clearly expecting.

“Yet I was unable,” she said. “I needed help.”

The common assumption that her love for her baby would make her recover only led to increased guilt and self-harm, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie at last met her, she was attached to tubes and leads, so tiny she thought she would break her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘What is our future?’” 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 nurse who had been so kind to her.

Medical personnel told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, results get better, foster placements fall and overall savings increase.

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 bring her to the facility.

She stepped out of the hospital still in withdrawal, anxious and doubtful about what would follow.

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At the facility, Stephanie still worried that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could arrive and take her baby away.

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. Addiction came first; reliance 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 care for herself, much less anyone else.

Every day, staff from the facility transported her to a clinic for methadone, provided orally. Gradually, she was embracing sobriety.

She devoted all her time 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 pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an specialist – all frequent conditions for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her posture is humble so you do not see her expression. She is presenting her daughter on her lap for the other kids to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if they could.

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

Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand 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 developed in 1975|