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In her eighth month of pregnancy and suffering, Stephanie Rosell visited the medical facility after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had built in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and threw up.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had a month remaining to figure out how to get clean and have this baby.

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

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

Five days later, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – premature, tiny yet healthy.

When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given shortly before she gave birth.

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

Stephanie had tried to get clean repeatedly before birth, and felt awful 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 clearly expecting.

“Yet I was unable,” she said. “I required assistance.”

The common assumption that her affection for her child would make her quit only led to deeper self-loathing and self-harm, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the NICU. When Stephanie finally saw her her, she was hooked up to tubes and leads, so small she thought she would hurt her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

After two days she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.

Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.

In much of the US, where a baby is identified with infant withdrawal condition frequently, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is proving a simple point: when mothers and babies stay together, recovery succeeds, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to collect her.

She departed the institution still in detox, scared and uncertain about what would come next.

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At the facility, Stephanie still feared that authorities would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could walk in and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about getting by. Addiction came first; trust came last.

Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She was unable to love herself, not to mention anyone else.

Each day, staff from the facility took her to a treatment center, administered in pill form. Over time, she was starting to get clean.

She utilized each moment beyond therapy 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 obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all frequent conditions for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. An advocate, a recovery coach, visited 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 awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is wearing black pants and a hoodie, a gray knit hat with a bobble on her head, resting on the floor with the entryway at her back. 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 standing close, admiring and touching to the baby.

Jacob, eight, asked the moms: “Why are there no men?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if possible.

“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.”

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

The assessment tool was developed in 1975|