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Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the medical facility after an infection began spreading up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”

She had used fentanyl 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 find a way to become sober and give birth.

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

“I will go,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named 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 periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie delivered a infant weighing just over four pounds – born before term, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been administered shortly before she gave birth.

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

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt hopeless, berating herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.

“But I couldn’t,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her stop using only led to greater shame and self-harm, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.

The infant was moved to the NICU. When Stephanie eventually visited her, she was connected to monitors, so small she thought she would break her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about Maddie’s Place, a new kind of care center where women and their babies are treated together, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a developing system of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, foster placements fall and future expenses reduce.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to collect her.

She stepped out of the hospital still in detox, fearful and unsure about what would follow.

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At the facility, Stephanie still was concerned that authorities would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could arrive and take her baby away.

For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about enduring. Drugs came first; reliance came last.

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to cause pain. She was unable to love herself, not to mention anyone else.

Every day, staff from the center transported her to a recovery program, administered in pill form. Slowly, she was embracing sobriety.

She utilized each moment 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 specialist – all typical problems for babies born with NAS.

When a child recognizes these infants need affection, then I was capable. I could parent.

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own children in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration 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 wearing black pants and a hoodie, a cap with a bobble on her head, resting on the floor with the door behind her. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her lap for the other kids to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there if they could.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could be a mom.”

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Tools for treating infants affected by substances have been used for a long time.

The Finnegan NAS scale was created in 1975|