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

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

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had consumed opioids before seeking medical help and had only a brief window to get treated before she needed to go home to get high again. She thought she still had four weeks left to plan her recovery and have this baby.

The nurse had other ideas. She told Stephanie she was staying put.

“Yes, I am,” 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 ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.

Five days later, on the 12th of November, Stephanie gave birth to a infant weighing 4lb 8oz – born before term, tiny yet healthy.

When the nurse asked if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her epidural had failed, her previous intake of fentanyl had been administered four hours before delivery.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.

“Yet I was unable,” she said. “I required assistance.”

The common assumption that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a trigger 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 NICU. When Stephanie finally saw her her, she was attached to monitors, so little she thought she would hurt her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

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

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a developing system of centers like the care home is showing an important truth: when parents and infants remain united, results get better, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to bring her to the facility.

She stepped out of the hospital still in detox, fearful and unsure about what would happen next.

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At Maddie’s Place, Stephanie still feared that CPS would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could arrive and separate them.

For the first two weeks, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about enduring. Addiction came first; faith came last.

Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to cause pain. She lacked the ability to love herself, not to mention anyone else.

Daily, staff from the facility took her to a recovery program, provided orally. Over time, she was embracing sobriety.

She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.

On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, visited with her own children in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in casual attire, a beanie with a bobble on her head, sitting on the wooden floor with the door behind her. She is lean. Her face is downcast so you miss her features. She is presenting her daughter on her lap for the children to see and they are crowding near, admiring and touching to the baby.

Jacob, eight, asked the moms: “Where are all the dads?” 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 plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.”

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Approaches for managing infants affected by substances have been used for a long time.

The Finnegan NAS scale was created in 1975|