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Pregnant and experiencing intense discomfort, Stephanie Rosell went to the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she lived in a shed she had constructed in a friend’s yard. She was also hooked on fentanyl.

As medical staff managed her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and threw up.

Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”

She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home to get high again. She thought she still had four weeks left to figure out how to get clean and deliver her child.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie delivered a infant weighing 4lb 8oz – early, small but alive.

When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her epidural had failed, 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 sought recovery several times during pregnancy, and felt terrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her dealer declined to supply to her when she became obviously with child.

“However, I failed,” she said. “I needed help.”

The widespread belief that her bond with her newborn would make her stop using only led to increased guilt and self-abuse, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.

The infant was moved to the special care nursery. When Stephanie at last met her, she was connected to monitors, so small she thought she would break her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.

Nurses and doctors told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when parents and infants remain united, recovery succeeds, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to bring her to the facility.

She left the medical center still in detox, anxious and doubtful about what would happen next.

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At the facility, Stephanie still was concerned that authorities would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and take her baby away.

For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

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

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She was unable to value herself, not to mention anyone else.

Daily, staff from the center transported her to a treatment center, provided orally. Slowly, she was beginning recovery.

She devoted all her time 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 feeding therapy. She also had sensory challenges and required an occupational therapist – all common issues for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, 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 young ones stared in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is wearing black pants and a hoodie, a gray knit hat with a decoration on her head, seated on the ground with the door behind her. She is lean. 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, showing interest to the baby.

One child, eight, asked the mothers: “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 plan to be a great parent. They will know they are valued.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could parent.”

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Tools for treating babies with exposure have been used for a long time.

The evaluation method was created in 1975|