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In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at 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 built in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”

She had taken the drug before coming to the ER and had only a brief window to get treated before she needed to go home to relapse. She thought she still had several weeks to figure out how to get clean and give birth.

The nurse had other ideas. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was serious, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

Five days later, on the 12th of November, Stephanie delivered a baby girl weighing 4lb 8oz – born before term, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been given four hours before delivery.

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

Stephanie had sought recovery several times during pregnancy, and felt terrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her supplier refused to sell to her when she became visibly pregnant.

“But I couldn’t,” she said. “I needed help.”

The pervasive expectation that her affection for her child would make her quit only led to increased guilt and self-harm, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to tubes and leads, so small she thought she would break her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still rushed to special care and medicated while their mothers face parental assessments. But a limited but expanding group of centers like this facility is proving a simple point: when mothers and babies stay together, recovery succeeds, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to pick her up.

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

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At the care center, Stephanie still was concerned that child services would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any point, someone could walk in and remove her child.

For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about survival. Addiction came first; faith 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 did not know how to love herself, not to mention anyone else.

Daily, staff from Maddie’s Place drove her to a recovery program, provided orally. Over time, she was beginning recovery.

She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an professional – all typical problems for babies born with NAS.

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

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a peer support specialist, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a bobble on her head, sitting on the wooden floor with the door behind her. She is lean. Her head is tilted forward so you do not see her expression. She is lifting the baby on her lap for the other kids to see and they are standing close, admiring and touching to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The parents responded that the men were occupied, handling responsibilities, that they would be there if possible.

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could parent.”

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Approaches for managing babies with exposure have existed for decades.

The Finnegan NAS scale was developed in 1975|