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Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the ER after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had built in a companion's property. She was also hooked on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

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

She had used fentanyl before coming to the ER and had only a brief window to get treated before she had to return to get high again. She thought she still had several weeks to figure out how to get clean and give birth.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

After five days, on the 12th of November, Stephanie gave birth to a daughter weighing 4lb 8oz – born before term, small but alive.

When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been provided four hours before delivery.

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

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she was unsuccessful. She felt without value, blaming herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her supplier would not provide to her when she became obviously with child.

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

The pervasive expectation that her love for her baby would make her quit only led to greater shame and negative self-talk, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The baby was taken to the NICU. When Stephanie finally saw her her, she was connected to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

After two days she decided to call her daughter Izzie, after the attendant who showed compassion to her.

Medical personnel told her about a care center, a new kind of care center 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) frequently, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when families are kept intact, results get better, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.

She departed the institution still in recovery, scared and uncertain about what would happen 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 moment, someone could arrive and separate them.

For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about survival. Addiction came first; reliance came last.

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to cause pain. She was unable to value herself, much less anyone else.

Daily, staff from the center took her to a clinic for methadone, provided orally. Over time, she was embracing sobriety.

She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all frequent conditions for babies affected by withdrawal.

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

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. An advocate, a peer support specialist, stopped by with her own children in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She has an image of the moment. She is wearing black pants and a hoodie, a beanie with a bobble on her head, resting on the floor with the entryway at her back. She is lean. Her posture is humble so you cannot see her face. She is lifting the baby on her lap for the young ones to see and they are standing close, admiring and touching to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the men were occupied, called away to other tasks, that they would be there if possible.

“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could be a mom.”

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Tools for treating drug-exposed newborns have been available for years.

The Finnegan NAS scale was created in 1975|