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Eight months pregnant and in severe pain, Stephanie Rosell went to the ER after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also dependent on fentanyl.

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

Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”

She had consumed opioids before coming to the ER and had just enough time to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and give birth.

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

“I am leaving,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

A short time later, on the 12th of November, Stephanie had a infant weighing a small weight – born before term, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been provided a few hours prior to birth.

She felt ill. Unprepared to be a mother. Unworthy.

Stephanie had tried to get clean several times during pregnancy, and felt awful each time she failed. She felt worthless, berating herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her source refused to sell to her when she became visibly pregnant.

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

The widespread belief that her love for her baby would make her quit only led to greater shame and self-harm, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.

The newborn was transferred to the special care nursery. When Stephanie at last met her, she was attached to tubes and leads, so tiny she thought she would hurt her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.

Hospital staff told her about Maddie’s Place, 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 neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a small, growing network of centers like this facility is showing an important truth: when families are kept intact, results get better, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to bring her to the facility.

She departed the institution still in withdrawal, scared and uncertain about what would happen next.

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At the facility, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could walk in and remove her child.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about survival. Substances came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She lacked the ability to care for herself, much less anyone else.

Each day, staff from the facility took her to a clinic for methadone, provided orally. Gradually, she was beginning recovery.

She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an specialist – all frequent conditions for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a peer support specialist, came over with her own family in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is clad in casual attire, a cap with a decoration on her head, resting on the floor with the door behind her. She is slender. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her knee for the other kids to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if possible.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could be a mom.”

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Methods to address babies with exposure have been used for a long time.

The Finnegan NAS scale was established in 1975|