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Eight months pregnant and in severe pain, Stephanie Rosell went to the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had assembled in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She slumped forward and became sick.

Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”

She had consumed opioids before seeking medical help and had just enough time to get treated before she had to return to relapse. She thought she still had a month remaining to plan her recovery and deliver her child.

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

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection was severe, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie had a baby girl weighing 4lb 8oz – premature, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.

She felt unwell. Unprepared to be a mother. Undeserving.

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her source refused to sell to her when she became clearly expecting.

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

The pervasive expectation that her bond with her newborn would make her recover only led to increased guilt and self-abuse, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was hooked up to monitors, so little she thought she would break her. Embracing her at last, she felt detached. “I looked at her and was like, ‘How will I care for you?’” 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 a care center, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is proving a simple point: when families are kept intact, results get better, fewer children enter care 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 departed the institution still in withdrawal, anxious and doubtful about what would follow.

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At the facility, Stephanie still feared that authorities would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could arrive and take her baby away.

For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”

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

Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She lacked the ability to love herself, much less anyone else.

Daily, staff from Maddie’s Place took her to a treatment center, administered in pill form. Over time, she was starting to get clean.

She spent every minute 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 pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an professional – all frequent conditions for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. An advocate, a peer support specialist, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a cap with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her posture is humble so you miss her features. She is holding Izzie up on her knee for the children to see and they are gathered around, showing interest to the baby.

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

“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and the specialist exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”

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Tools for treating infants affected by substances have been used for a long time.

The evaluation method was developed in 1975|