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In her eighth month of pregnancy and suffering, Stephanie Rosell went to the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had built in a companion's property. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and became sick.

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

She had taken the drug before seeking medical help and had just enough time to get treated before she had to return to relapse. She thought she still had several weeks 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 am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

A short time later, on the 12th of November, Stephanie delivered a infant weighing just over four pounds – born before term, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been given a few hours prior to birth.

She felt unwell. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her source would not provide to her when she became obviously with child.

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

The common assumption that her love for her baby would make her stop using only led to increased guilt and negative self-talk, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was attached to medical equipment, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure 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 women and their babies are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with infant withdrawal condition frequently, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a developing system of centers like the care home is proving a simple point: 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 eventually made the call. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.

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

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At the care center, Stephanie still feared that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could enter and remove her child.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to care for herself, not to mention anyone else.

Each 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 girl had some trouble feeding at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies born with NAS.

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

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a peer support specialist, came over with her own children in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She holds a picture of the moment. She is wearing casual attire, a beanie with a bobble on her head, seated on the ground with the exit nearby. She is lean. Her face is downcast so you do not see her expression. She is holding Izzie up on her knee for the other kids to see and they are standing close, admiring and touching to the baby.

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

“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I would become a mother.”

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

The assessment tool was created in 1975|