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In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the ER after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and threw up.

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before seeking medical help and had just enough time 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 give birth.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie gave birth to a daughter weighing just over four pounds – early, little but surviving.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her epidural had failed, her last dose 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 multiple times while expecting, and felt terrible each time she relapsed. She felt worthless, berating herself for not being able to achieve the unattainable. An OBGYN 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 pervasive expectation that her love for her baby would make her recover only led to deeper self-loathing and self-harm, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could will away a persistent condition.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was attached to medical equipment, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to give her child the name Izzie, after the attendant who showed compassion to her.

Hospital staff told her about a specialized facility, a unique recovery environment where women and their babies are treated together, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, foster placements fall and future expenses reduce.

It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, two staff members came to collect her.

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

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At Maddie’s Place, Stephanie still feared that child services would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could enter and separate them.

For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about getting by. Drugs came first; reliance came last.

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

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

She devoted all her time beyond therapy 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 sensory challenges and required an occupational therapist – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. An advocate, a peer support specialist, stopped by with her own five kids 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 tiny infant 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 holds a picture of the moment. She is wearing black pants and a hoodie, a beanie with a pompom on her head, seated on the ground with the exit nearby. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her leg for the other kids to see and they are crowding near, fawning and reaching out to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there given the chance.

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

Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. 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|