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Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after an infection began spreading up her legs. Without a job or home, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and became sick.

Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”

She had used fentanyl before coming to the ER and had just enough time to get treated before she needed to go home to relapse. She thought she still had four weeks left to find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“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 leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

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

When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been given a few hours prior to birth.

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

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she failed. She felt worthless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her supplier refused to sell to her when she became visibly pregnant.

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

The common assumption that her affection for her child would make her recover only led to greater shame and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to monitors, so little she thought she would harm her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

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

Nurses and doctors told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a small, growing network of centers like this facility is proving a simple point: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to collect her.

She departed the institution still in recovery, anxious and doubtful about what would follow.

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At the care center, Stephanie still worried that CPS would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any time, someone could enter and separate them.

For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about enduring. Addiction 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 let her down. She lacked the ability to love herself, let alone anyone else.

Every day, staff from the facility transported her to a recovery program, administered in pill form. Gradually, she was starting to get clean.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies exposed to substances.

Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a peer support specialist, came over with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing casual attire, a gray knit hat with a pompom on her head, resting on the floor with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her leg for the young ones to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could parent.”

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Approaches for managing drug-exposed newborns have been available for years.

The evaluation method was developed in 1975|