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Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after her infection worsened up her legs. Without a job or home, separated from loved ones, she lived in a shed she had constructed in a companion's property. She was also dependent on fentanyl.

As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and became sick.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she had to return to relapse. She thought she still had several weeks to figure out how to get clean and have this baby.

The attending nurse disagreed. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the leg infection was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

Five days later, on a day in November 2022, Stephanie gave birth to a daughter weighing a small weight – early, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been given shortly before she gave birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she failed. She felt worthless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her source would not provide to her when she became obviously with child.

“But I couldn’t,” she said. “I needed help.”

The pervasive expectation that her love for her baby would make her quit only led to increased guilt and self-harm, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was connected to monitors, so tiny she thought she would break her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.

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

In numerous states, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a small, growing network of centers like this facility is showing an important truth: when parents and infants remain united, recovery succeeds, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to collect her.

She stepped out of the hospital still in recovery, fearful and unsure about what would come next.

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At the facility, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could arrive and take her baby away.

For the first two weeks, Stephanie stayed withdrawn. “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 enduring. Drugs came first; reliance came last.

Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to hurt her. She lacked the ability to value herself, not to mention anyone else.

Every day, staff from the center transported her to a recovery program, provided orally. Over time, she was beginning recovery.

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 sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an specialist – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. A support specialist, a recovery coach, visited with her own children in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She has an image of the moment. She is clad in black pants and a hoodie, a beanie with a decoration on her head, sitting on the wooden floor 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 standing close, admiring and touching to the baby.

One child, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the men were occupied, called away to other tasks, that they would be there if they could.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could parent.”

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Approaches for managing infants affected by substances have been available for years.

The evaluation method was created in 1975|