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Eight months pregnant and in severe pain, Stephanie Rosell visited the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had assembled in a friend’s yard. She was also dependent on fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and threw up.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had several weeks to figure out how to get clean and have this baby.

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

“Yes, I am,” 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, Izzie, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

A short time later, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – early, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered four hours before delivery.

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

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she relapsed. She felt worthless, berating herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her source refused to sell to her when she became obviously with child.

“However, I failed,” she said. “I had to seek support.”

The widespread belief that her bond with her newborn would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to relapse. 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 hooked up to monitors, so tiny she thought she would break her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees 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 worried that child services would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could enter and take her baby away.

For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about enduring. Drugs came first; faith came last.

Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She was unable to care for herself, let alone anyone else.

Each day, staff from the center drove her to a treatment center, provided orally. Slowly, she was starting to get clean.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all typical problems for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is wearing black pants and a hoodie, a gray knit hat with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her leg for the children to see and they are crowding near, fawning and reaching out to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there if possible.

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

Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I was able. I would become a mother.”

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Approaches for managing infants affected by substances have existed for decades.

The Finnegan NAS scale was developed in 1975|