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Eight months pregnant and in severe pain, Stephanie Rosell visited the ER after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a companion's property. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and vomited.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”

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 relapse. She thought she still had several weeks to figure out how to get clean and deliver her child.

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

“I will go,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.

A short time later, on 12 November 2022, Stephanie had a baby girl weighing just over four pounds – born before term, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been provided four hours before delivery.

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

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she failed. She felt without value, blaming herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her supplier would not provide to her when she became visibly pregnant.

“However, I failed,” she said. “I required assistance.”

The common assumption that her affection for her child would make her stop using only led to increased guilt and self-harm, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.

The infant was moved to the NICU. When Stephanie at last met her, she was hooked up to monitors, so small she thought she would break her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

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

Hospital staff told her about a care center, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In numerous states, where a baby is identified with newborn addiction symptoms regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to pick her up.

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 feared that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could arrive and separate them.

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

Homelessness, she said, was about getting by. Drugs came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to hurt her. She lacked the ability to care for herself, let alone anyone else.

Each day, staff from the facility drove her to a recovery program, administered in pill form. Over time, she was embracing sobriety.

She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. An advocate, a mentor, visited with her own family in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She keeps a photo 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 door behind her. She is slender. Her face is downcast so you cannot see her face. She is holding Izzie up on her lap for the young ones to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if they could.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I was able. I would become a mother.”

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Approaches for managing babies with exposure have existed for decades.

The evaluation method was created in 1975|