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Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the ER after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had built in a companion's property. She was also addicted to fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”

She had taken the drug before coming to the ER and had just enough time to get treated before she was compelled to leave to relapse. She thought she still had a month remaining to plan her recovery and give birth.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, 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 switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

After five days, on 12 November 2022, Stephanie delivered a baby girl weighing a small weight – early, tiny yet healthy.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been administered a few hours prior to birth.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had sought recovery repeatedly before birth, and felt awful each time she failed. She felt worthless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her supplier refused to sell to her when she became visibly pregnant.

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

The pervasive expectation that her love for her baby would make her recover only led to deeper self-loathing and self-harm, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the NICU. When Stephanie eventually visited her, she was connected to monitors, so tiny she thought she would break her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to name her baby Izzie, after the nurse who had been so kind to her.

Hospital staff told her about a care center, a new kind of care center where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a developing system of centers like this facility is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.

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

She left the medical center still in detox, scared and uncertain about what would happen next.

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At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could enter and remove her child.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about getting by. Drugs came first; faith came last.

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to cause pain. She lacked the ability to care for herself, much less anyone else.

Every day, staff from the center took her to a recovery program, provided orally. Over time, she was starting to get clean.

She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.

During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, visited with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She has an image of the moment. She is dressed in casual attire, a cap with a bobble on her head, resting on the floor with the entryway at her back. She is thin. Her face is downcast so you miss her features. She is holding Izzie up on her lap for the young ones to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could be a mom.”

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Approaches for managing babies with exposure have been used for a long time.

The assessment tool was established in 1975|