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Pregnant and experiencing intense discomfort, Stephanie Rosell went to the ER after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she resided in a small structure she had assembled in a acquaintance's garden. She was also dependent on fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”

She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to plan her recovery and deliver her child.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was serious, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

After five days, on the 12th of November, Stephanie had a daughter weighing just over four pounds – premature, small but alive.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given a few hours prior to birth.

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

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.

“However, I failed,” she said. “I needed help.”

The common assumption that her bond with her newborn would make her recover only led to deeper self-loathing and self-harm, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was hooked up to medical equipment, so small she thought she would hurt her. Cradling her initially, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

After two days she decided to call her daughter Izzie, after the professional who provided support to her.

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

In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is showing an important truth: when families are kept intact, recovery succeeds, foster placements fall and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to pick her up.

She left the medical center still in withdrawal, anxious and doubtful about what would follow.

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At Maddie’s Place, Stephanie still feared that child services would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any time, someone could enter and remove her child.

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

Survival outdoors, she said, was about getting by. Addiction came first; trust came last.

Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to let her down. She did not know how to love herself, let alone anyone else.

Each day, staff from the center transported her to a treatment center, provided orally. Over time, she was starting to get clean.

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 sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

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

One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. An advocate, a mentor, 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 young ones stared in awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She holds a picture of the moment. She is wearing black pants and a hoodie, a gray knit hat with a pompom on her head, seated on the ground with the exit nearby. She is slender. Her posture is humble so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are standing close, admiring and touching to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could be a mom.”

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Tools for treating babies with exposure have been available for years.

The Finnegan NAS scale was developed in 1975|