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In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had constructed in a companion's property. She was also hooked on fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and threw up.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”

She had taken the drug before seeking medical help and had only a brief window to get treated before she needed to go home to use once more. She thought she still had several weeks to plan her recovery and have this baby.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was critical, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie had a infant weighing 4lb 8oz – premature, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been given shortly before she gave birth.

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

Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer would not provide to her when she became obviously with child.

“But I couldn’t,” she said. “I required assistance.”

The pervasive expectation that her love for her baby would make her quit only led to increased guilt and negative self-talk, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to monitors, so tiny she thought she would break her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

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

Nurses and doctors told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is proving a simple point: when families are kept intact, outcomes improve, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.

She departed the institution still in detox, scared and uncertain about what would happen next.

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At the care center, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could enter and take her baby away.

For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”

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

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

Every day, staff from the facility took her to a treatment center, provided orally. Slowly, she was starting to get clean.

She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an specialist – all typical problems for babies born with NAS.

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

During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, 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 kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She keeps a photo of the moment. She is dressed in casual attire, a cap with a bobble on her head, seated on the ground with the exit nearby. She is thin. Her head is tilted forward so you cannot see her face. She is lifting the baby on her lap for the children to see and they are crowding near, admiring and touching to the baby.

Jacob, eight, asked the moms: “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’m going to be the best dad ever. I will teach them about love.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could be a mom.”

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Methods to address drug-exposed newborns have been used for a long time.

The Finnegan NAS scale was created in 1975|