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In her eighth month of pregnancy and suffering, Stephanie Rosell visited the medical facility after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had constructed in a acquaintance's garden. She was also dependent on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and became sick.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had a month remaining to plan her recovery and have this baby.

The attending nurse disagreed. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.

After five days, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – premature, tiny yet healthy.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been given a few hours prior to birth.

She felt unwell. Ill-equipped for parenting. Undeserving.

Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she was unsuccessful. She felt without value, berating herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became clearly expecting.

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

The common assumption that her affection for her child would make her stop using only led to deeper self-loathing and self-abuse, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the NICU. When Stephanie at last met her, she was hooked up to monitors, so tiny she thought she would hurt her. Embracing her at last, she felt nothing. “I gazed upon 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 after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about a care center, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, results get better, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to collect her.

She left the medical center still in recovery, fearful and unsure about what would happen next.

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At the facility, Stephanie still was concerned that authorities would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could walk in and remove her child.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, 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 hurt her. She did not know how to care for herself, much less anyone else.

Daily, staff from the facility took her to a treatment center, provided orally. Slowly, she was beginning recovery.

She devoted all her time outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies exposed to substances.

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 was in the common room, where those still using can come for guided meetings with their babies. A support specialist, a mentor, stopped by with her own children in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” 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 gray knit hat with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her posture is humble so you cannot see her face. She is presenting her daughter on her leg for the other kids to see and they are standing close, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there given the chance.

“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could parent.”

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Approaches for managing drug-exposed newborns have been used for a long time.

The evaluation method was created in 1975|