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In her eighth month of pregnancy and suffering, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had assembled in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and vomited.

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

She had taken the drug before coming to the ER and had only a brief window to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and have this baby.

The nurse had other ideas. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the leg infection was critical, but physicians found 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 controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.

After five days, on a day in November 2022, Stephanie delivered a daughter weighing just over four pounds – born before term, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was detached. Her epidural had failed, her previous intake of fentanyl had been administered shortly before she gave birth.

She felt unwell. Unprepared to be a mother. Undeserving.

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she relapsed. She felt without value, berating herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her supplier would not provide to her when she became clearly expecting.

“Yet I was unable,” she said. “I had to seek support.”

The widespread belief that her bond with her newborn would make her stop using only led to greater shame and self-harm, 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 infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to tubes and leads, so small she thought she would break her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In many parts of America, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when families are kept intact, outcomes improve, foster placements fall and overall savings increase.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to bring her to the facility.

She stepped out of the hospital still in detox, scared and uncertain about what would happen next.

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At the facility, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could walk in and separate them.

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

Survival outdoors, she said, was about enduring. Drugs came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She lacked the ability to care for herself, much less anyone else.

Daily, staff from the center drove her to a treatment center, provided orally. Gradually, she was embracing sobriety.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all typical problems for babies exposed to substances.

Seeing that even a young person understands the need for care, then I could do this. I could parent.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. An advocate, a recovery coach, visited with her own five kids in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She has an image of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a decoration on her head, resting on the floor with the exit nearby. She is thin. Her posture is humble so you miss her features. She is presenting her daughter on her knee for the young ones to see and they are standing close, admiring and touching to the baby.

A young boy, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if they could.

“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could parent.”

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Approaches for managing infants affected by substances have been used for a long time.

The assessment tool was established in 1975|