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Eight months pregnant and in severe pain, Stephanie Rosell arrived at the hospital emergency room after her infection worsened up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had built in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. 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 get high.”

She had taken the drug before coming to the ER and had sufficient opportunity 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 deliver her child.

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

“I will go,” Stephanie said.

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

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

Five days later, on the 12th of November, Stephanie delivered a infant weighing just over four pounds – early, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her previous intake of fentanyl had been given a few hours prior to birth.

She felt ill. Unprepared to be a mother. Not fit.

Stephanie had sought recovery multiple times while expecting, and felt horrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her source declined to supply to her when she became clearly expecting.

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

The common assumption that her bond with her newborn would make her stop using only led to deeper self-loathing and negative self-talk, a cause 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 NICU. When Stephanie at last met her, she was connected to tubes and leads, so tiny she thought she would break her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

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

Medical personnel told her about Maddie’s Place, a innovative treatment home where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, foster placements fall and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.

She left the medical center still in detox, scared and uncertain about what would come next.

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At the facility, Stephanie still worried that CPS would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could walk in and remove her child.

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

Homelessness, she said, was about enduring. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to cause pain. She was unable to love herself, not to mention anyone else.

Every day, staff from the center took her to a treatment center, provided orally. Gradually, she was beginning recovery.

She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had sensory challenges and required an occupational therapist – all typical problems for babies exposed to substances.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. A support specialist, a peer support specialist, came over with her own family in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

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

She holds a picture of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a decoration on her head, resting on the floor with the door behind her. She is thin. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her leg for the other kids to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the moms: “Why are there no men?” The parents responded that the dads were busy, called away to other tasks, that they would be there given the chance.

“When I have kids,” 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. “Seeing that even youth understand that newborns require care, then I found the courage. I could parent.”

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Tools for treating infants affected by substances have been available for years.

The evaluation method was created in 1975|