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Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had built in a friend’s yard. She was also addicted to fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she needed to go home to get high again. She thought she still had several weeks to plan her recovery and deliver her child.

The medical professional intervened. 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 medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

After five days, on the 12th of November, Stephanie delivered a baby girl weighing 4lb 8oz – early, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been provided a few hours prior to birth.

She felt unwell. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her source refused to sell to her when she became obviously with child.

“However, I failed,” she said. “I needed help.”

The pervasive expectation that her bond with her newborn would make her quit only led to greater shame and self-abuse, a cause for her to relapse. Yet she could not simply will 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 hooked up to tubes and leads, so little she thought she would harm her. Cradling her initially, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to name her baby after her caregiver, after the nurse who had been so kind to her.

Hospital staff 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 identified 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 proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.

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 come next.

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At the facility, Stephanie still was concerned that CPS would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could arrive and remove her child.

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

Life on the streets, she said, was about survival. Substances came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She did not know how to love herself, much less anyone else.

Every day, staff from Maddie’s Place transported her to a recovery program, provided orally. Gradually, she was starting to get clean.

She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an specialist – all common issues for babies born with NAS.

When a child recognizes these infants need affection, then I could do this. I would become a mother.

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” 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 decoration on her head, resting on the floor with the door behind her. She is thin. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her lap for the young ones to see and they are crowding near, fawning and reaching out to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I would become a mother.”

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Tools for treating babies with exposure have been available for years.

The Finnegan NAS scale was established in 1975|