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In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the ER after an infection began spreading up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also hooked on fentanyl.

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

Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she needed to go home to get high again. She thought she still had a month remaining to find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the leg infection was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.

Five days later, on the 12th of November, Stephanie gave birth to a infant weighing a small weight – early, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her epidural had failed, her previous intake of fentanyl had been given four hours before delivery.

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

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she failed. She felt hopeless, berating herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her source declined to supply to her when she became visibly pregnant.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her affection for her child would make her recover only led to deeper self-loathing and negative self-talk, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was connected to monitors, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to name her baby Izzie, after the nurse who had been so kind to her.

Hospital staff told her about Maddie’s Place, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In numerous states, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, outcomes improve, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she finally did. After confirming she would be a good fit for the program, care providers came to pick her up.

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

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At the care center, Stephanie still was concerned that CPS would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could arrive and take her baby away.

For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about getting by. Addiction came first; trust came last.

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She did not know how to love herself, not to mention anyone else.

Every day, staff from the facility took her to a clinic for methadone, provided orally. Gradually, she was embracing sobriety.

She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an professional – all common issues for babies exposed to substances.

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 monitored interactions with their babies. An advocate, a peer support specialist, stopped by with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is dressed in casual attire, a beanie with a decoration 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 lifting the baby on her lap for the other kids to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if they could.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I would become a mother.”

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Tools for treating infants affected by substances have existed for decades.

The assessment tool was established in 1975|