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

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

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to figure out how to get clean and deliver her child.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

After five days, on the 12th of November, Stephanie had a infant weighing a small weight – premature, 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 previous intake of fentanyl had been administered four hours before delivery.

She felt sick. Ill-equipped for parenting. Undeserving.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she relapsed. She felt hopeless, berating herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her source declined to supply to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her stop using only led to deeper self-loathing and self-harm, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was attached to medical equipment, so little she thought she would hurt her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.

Hospital staff told her about a care center, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is identified with infant withdrawal condition regularly, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is proving a simple point: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to pick her up.

She stepped out of the hospital still in withdrawal, scared and uncertain about what would happen next.

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At the care center, Stephanie still feared that child services would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and remove her child.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about survival. Addiction came first; trust came last.

Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to value herself, let alone anyone else.

Every day, staff from the center took her to a recovery program, given as medication. Over time, she was embracing sobriety.

She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, visited with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground 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. None of those things mattered to them.”

She has an image of the moment. She is wearing black pants and a hoodie, a cap with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her posture is humble so you cannot see her face. She is holding Izzie up on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.

A young boy, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the men were occupied, called away to other tasks, that they would be there given the chance.

“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 looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I would become a mother.”

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Methods to address infants affected by substances have been available for years.

The assessment tool was developed in 1975|