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In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a friend’s yard. She was also dependent on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and vomited.

Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital 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 figure out how to get clean and deliver her child.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was critical, but physicians found 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.

She encouraged the doctor to give Stephanie regulated amounts 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 often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie gave birth to a daughter weighing a small weight – early, tiny yet healthy.

When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been administered four hours before delivery.

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

Stephanie had sought recovery multiple times while expecting, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

“However, I failed,” she said. “I required assistance.”

The widespread belief that her love for her baby would make her recover only led to deeper self-loathing and self-harm, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to monitors, so tiny she thought she would break her. Cradling her initially, she felt detached. “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 Izzie, after the nurse who had been so kind to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like this facility is demonstrating a key fact: when parents and infants remain united, results get better, custody cases decrease and future expenses reduce.

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

She departed the institution still in recovery, scared and uncertain about what would happen next.

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At the facility, Stephanie still was concerned that CPS would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and separate them.

For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about enduring. Drugs came first; faith came last.

Stephanie had a single companion, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She was unable to care for herself, let alone anyone else.

Each day, staff from Maddie’s Place transported her to a clinic for methadone, provided orally. Slowly, she was starting to get clean.

She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies born with NAS.

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 individuals struggling with substance use can come for guided meetings 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 resting on the carpet holding Izzie.

The young ones stared in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She holds a picture of the moment. She is clad in black pants and a hoodie, a gray knit hat with a decoration on her head, resting on the floor with the door behind her. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her knee for the other kids to see and they are standing close, fawning and reaching out to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The parents responded that the fathers had obligations, called away to other tasks, 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 looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I would become a mother.”

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Methods to address drug-exposed newborns have existed for decades.

The evaluation method was established in 1975|