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Pregnant and experiencing intense discomfort, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed 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 only a brief window to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was critical, 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 face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.

After five days, on 12 November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – born before term, 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 previous intake of fentanyl had been given a few hours prior to birth.

She felt ill. Not ready for motherhood. Not fit.

Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she was unsuccessful. She felt hopeless, berating herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer declined to supply to her when she became obviously with child.

“But I couldn’t,” she said. “I needed help.”

The widespread belief that her affection for her child would make her recover only led to greater shame and negative self-talk, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to medical equipment, so small she thought she would break her. Embracing her at last, she felt nothing. “I just stared at 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 give her child the name the same as her nurse, after the professional who provided support 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 newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to collect her.

She left the medical center still in recovery, scared and uncertain about what would come next.

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At the care center, Stephanie still was concerned that CPS would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could walk in and separate them.

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

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

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to value herself, not to mention anyone else.

Each day, staff from the center transported her to a clinic for methadone, administered in pill form. Gradually, she was beginning recovery.

She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all common issues for babies affected by withdrawal.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. An advocate, a mentor, stopped by with her own family in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is clad in black pants and a hoodie, a cap with a bobble on her head, sitting on the wooden floor with the exit nearby. She is thin. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her knee for the young ones to see and they are standing close, fawning and reaching out to the baby.

One child, eight, asked the moms: “Why are there no men?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I could be a mom.”

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

The Finnegan NAS scale was created in 1975|