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Pregnant and experiencing intense discomfort, Stephanie Rosell went to the medical facility after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.

As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and vomited.

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

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had several weeks to find a way to become sober 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 doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

A short time later, on 12 November 2022, Stephanie had a baby girl weighing a small weight – early, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she relapsed. She felt worthless, berating herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her source would not provide to her when she became obviously with child.

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

The widespread belief that her affection for her child would make her quit only led to deeper self-loathing and negative self-talk, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the NICU. When Stephanie eventually visited her, she was attached to medical equipment, so little she thought she would break her. Holding her for the first time, she felt empty. “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 give her child the name Izzie, after the nurse who had been so kind to her.

Nurses and doctors told her about a specialized facility, 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 found to have infant withdrawal condition regularly, infants are still rushed to special care and treated with pharmaceuticals 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, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to collect her.

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 feared that authorities would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could enter and remove her child.

For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about enduring. Substances came first; reliance came last.

Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to let her down. She lacked the ability to value herself, not to mention anyone else.

Every day, staff from Maddie’s Place transported her to a recovery program, administered in pill form. Gradually, she was starting to get clean.

She spent every minute outside treatment 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 severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own family in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a cap with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her posture is humble so you cannot see her face. She is presenting her daughter on her leg for the children to see and they are crowding near, showing interest to the baby.

A young boy, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there if possible.

“When I have kids,” 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 just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could parent.”

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Methods to address infants affected by substances have existed for decades.

The evaluation method was developed in 1975|