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In her eighth month of pregnancy and suffering, Stephanie Rosell went to the ER after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also dependent on fentanyl.

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

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

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had several weeks to plan her recovery and deliver her child.

The medical professional intervened. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was serious, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, 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.

A short time later, on the 12th of November, Stephanie had a daughter weighing just over four pounds – premature, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her final administration of fentanyl had been given shortly before she gave birth.

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

Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier declined to supply to her when she became clearly expecting.

“However, I failed,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her quit only led to increased guilt and self-harm, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the NICU. When Stephanie finally saw her 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 is our future?’” She continued to doubt 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.

Medical personnel told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is identified with infant withdrawal condition regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, two staff members came to bring her to the facility.

She stepped out of the hospital still in withdrawal, 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 not sure she wanted to keep her. The concern persisted: that at any moment, someone could arrive and take her baby away.

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

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

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She lacked the ability to love herself, let alone anyone else.

Each day, staff from the facility took her to a treatment center, administered in pill form. Over time, she was beginning recovery.

She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all common issues for babies affected by withdrawal.

When a child recognizes these infants need affection, then I could do this. I would become a mother.

During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. An advocate, a peer support specialist, stopped by 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 admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a pompom on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast so you miss her features. She is presenting her daughter on her knee for the young ones to see and they are gathered around, admiring and touching to the baby.

One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could parent.”

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Approaches for managing babies with exposure have been available for years.

The Finnegan NAS scale was developed in 1975|