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Eight months pregnant and in severe pain, Stephanie Rosell went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and became sick.

Stephanie finally broke down. “I need to leave. 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 was compelled to leave to get high again. She thought she still had four weeks left to find a way to become sober and have this baby.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.

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 switched to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – early, tiny yet healthy.

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

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

Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she relapsed. She felt worthless, berating herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier refused to sell to her when she became clearly expecting.

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

The widespread belief that her bond with her newborn would make her recover only led to increased guilt and self-harm, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie at last met her, she was hooked up to tubes and leads, so tiny she thought she would hurt her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to give her child the name Izzie, after the attendant who showed compassion to her.

Medical personnel told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a small, growing network of centers like this facility is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. 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 recovery, fearful and unsure about what would happen next.

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At the care center, Stephanie still feared that CPS would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could arrive and take her baby away.

For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about enduring. Substances came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She was unable to love herself, much less anyone else.

Each day, staff from Maddie’s Place transported her to a recovery program, given as medication. Gradually, she was starting to get clean.

She spent every minute 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 adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all common issues for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. A support specialist, a peer support specialist, stopped by with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, seated on the ground with the exit nearby. She is slender. Her face is downcast so you cannot see her face. She is lifting the baby on her lap for the children to see and they are crowding near, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “Where are all the dads?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I could be a mom.”

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Approaches for managing drug-exposed newborns have existed for decades.

The assessment tool was created in 1975|