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In her eighth month of pregnancy and suffering, Stephanie Rosell visited the ER after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had built in a companion's property. She was also dependent on fentanyl.

As doctors treated her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before coming to the ER 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 have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.

After five days, on a day in November 2022, Stephanie had a infant weighing a small weight – early, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her pain relief did not work, her last dose of fentanyl had been administered shortly before she gave birth.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she failed. She felt without value, blaming herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her supplier would not provide to her when she became obviously with child.

“However, I failed,” she said. “I required assistance.”

The pervasive expectation that her affection for her child would make her quit only led to greater shame and self-abuse, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to medical equipment, so little she thought she would harm her. Embracing her at last, she felt empty. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to give her child the name the same as her nurse, after the nurse who had been so kind to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition regularly, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a developing system of centers like this facility is demonstrating a key fact: 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 eventually made the call. After verifying her eligibility for the program, a couple of employees came to pick her up.

She departed the institution still in recovery, anxious and doubtful about what would follow.

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At the facility, Stephanie still feared that child services would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could arrive and remove her child.

For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence 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 people she loved always found ways to cause pain. She did not know how to care for herself, not to mention anyone else.

Each day, staff from Maddie’s Place took her to a clinic for methadone, 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 obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all common issues for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I was capable. I could be a mom.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, came over with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is clad in casual attire, a cap with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her posture is humble so you miss her features. She is holding Izzie up on her lap for the children to see and they are crowding near, admiring and touching to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The parents responded that the dads were busy, 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’m gonna show them that they deserve to be loved.”

Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”

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Methods to address babies with exposure have existed for decades.

The Finnegan NAS scale was established in 1975|