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Eight months pregnant and in severe pain, Stephanie Rosell went to the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had built in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. Withdrawal was setting in. She slumped forward and threw up.

Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”

She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had several weeks to find a way to become sober and deliver her child.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

After five days, on a day in November 2022, Stephanie gave birth to a infant weighing a small weight – born before term, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her epidural had failed, her previous intake of fentanyl had been provided four hours before delivery.

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

Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt without value, berating herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her dealer declined to supply to her when she became visibly pregnant.

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

The pervasive expectation that her bond with her newborn would make her stop using only led to greater shame and self-abuse, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so little she thought she would hurt her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

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

Hospital staff told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In numerous states, where a baby is found to have newborn addiction symptoms frequently, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when families are kept intact, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she finally did. 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 happen next.

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At Maddie’s Place, Stephanie still worried that child services would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could enter and separate them.

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

Survival outdoors, she said, was about enduring. Substances came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to let her down. She was unable to value herself, let alone anyone else.

Daily, staff from the facility drove her to a clinic for methadone, given as medication. Gradually, she was starting to get clean.

She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an professional – all common issues for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.

One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, visited with her own children in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a pompom on her head, seated on the ground with the door behind her. She is slender. Her face is downcast so you miss her features. She is presenting her daughter on her lap for the young ones to see and they are gathered around, showing interest to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if possible.

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

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I would become a mother.”

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Methods to address babies with exposure have been available for years.

The assessment tool was developed in 1975|