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Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the ER after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had built in a friend’s yard. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.

Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to plan her recovery and deliver her child.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was serious, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie delivered a baby girl weighing a small weight – premature, small but alive.

When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.

She felt ill. Ill-equipped for parenting. Not fit.

Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she relapsed. She felt worthless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her source refused to sell to her when she became obviously with child.

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

The pervasive expectation that her affection for her child would make her recover only led to deeper self-loathing and negative self-talk, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the NICU. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would break her. Embracing her at last, she felt detached. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to name her baby after her caregiver, after the attendant who showed compassion to her.

Hospital staff told her about a care center, a innovative treatment home where women and their babies are treated together, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition frequently, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like the care home is demonstrating a key fact: when parents and infants remain united, outcomes improve, custody cases decrease and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to bring her to the facility.

She departed the institution still in withdrawal, scared and uncertain about what would follow.

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At the facility, Stephanie still was concerned that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could arrive and take her baby away.

For the beginning period, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

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

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She lacked the ability to value herself, let alone anyone else.

Each day, staff from Maddie’s Place drove her to a recovery program, provided orally. Over time, she was embracing sobriety.

She devoted all her time beyond therapy 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 pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all typical problems for babies born with NAS.

When a child recognizes these infants need affection, then I found the strength. I could parent.

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for guided meetings with their babies. An advocate, a recovery coach, stopped by with her own family in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. 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, showing interest to the baby.

A young boy, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there given the chance.

“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”

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 assessment tool was developed in 1975|