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Pregnant and experiencing intense discomfort, Stephanie Rosell went to the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”

She had taken the drug before arriving at the hospital and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to plan her recovery and deliver her child.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was critical, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

After five days, on 12 November 2022, Stephanie delivered a infant weighing 4lb 8oz – born before term, tiny yet healthy.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her epidural had failed, her previous intake of fentanyl had been given shortly before she gave birth.

She felt sick. Not ready for motherhood. Undeserving.

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

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

The common assumption that her bond with her newborn would make her stop using only led to deeper self-loathing and self-harm, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the special care nursery. When Stephanie at last met her, she was hooked up to tubes and leads, so tiny she thought she would hurt her. Embracing her at last, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to call her daughter Izzie, after the professional who provided support 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 much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like this facility is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.

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 collect her.

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

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At the facility, Stephanie still feared that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could enter and separate them.

For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about survival. Addiction came first; reliance came last.

Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to cause pain. She lacked the ability to care for herself, much less anyone else.

Every day, staff from the facility took her to a recovery program, provided orally. Over time, she was starting to get clean.

She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – 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 be a mom.

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. An advocate, a recovery coach, stopped by with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared 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. Such issues were irrelevant.”

She keeps a photo of the moment. She is dressed in casual attire, a beanie with a decoration on her head, seated on the ground with the exit nearby. She is slender. Her face is downcast so you cannot see her face. She is holding Izzie up on her lap for the young ones to see and they are standing close, admiring and touching to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the men were occupied, handling responsibilities, that they would be there if they could.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I would become a mother.”

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Methods to address drug-exposed newborns have been used for a long time.

The evaluation method was developed in 1975|