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In her eighth month of pregnancy and suffering, Stephanie Rosell went to the ER after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built in a companion's property. She was also dependent on fentanyl.

As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and became sick.

Stephanie ultimately gave in. “I have to get out of here. 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 use once more. She thought she still had four weeks left to find a way to become sober and give birth.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie had a baby girl weighing 4lb 8oz – premature, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been provided a few hours prior to birth.

She felt unwell. Ill-equipped for parenting. Unworthy.

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she relapsed. She felt worthless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her source declined to supply to her when she became visibly pregnant.

“But I couldn’t,” she said. “I required assistance.”

The common assumption that her love for her baby would make her recover only led to increased guilt 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 persistent condition.

The infant was moved to the NICU. When Stephanie eventually visited her, she was hooked up to medical equipment, so little she thought she would break her. Cradling her initially, she felt nothing. “I looked 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 name her baby the same as her nurse, after the nurse who had been so kind to her.

Medical personnel told her about a specialized facility, a unique recovery environment where women and their babies are treated together, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, results get better, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to collect her.

She departed the institution still in withdrawal, anxious and doubtful about what would happen next.

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At Maddie’s Place, Stephanie still was concerned that authorities would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could arrive and separate them.

For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”

Homelessness, she said, was about enduring. Substances came first; trust 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 value herself, not to mention anyone else.

Each day, staff from the center took her to a clinic for methadone, administered in pill form. Slowly, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an occupational therapist – all common issues for babies born with NAS.

When a child recognizes these infants need affection, then I could do this. I could be a mom.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, came over with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She has an image of the moment. She is clad in black pants and a hoodie, a cap with a decoration on her head, resting on the floor with the exit nearby. She is slender. Her head is tilted forward so you miss her features. She is presenting her daughter on her lap for the other kids to see and they are crowding near, showing interest to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could parent.”

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Approaches for managing babies with exposure have been available for years.

The assessment tool was created in 1975|