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In her eighth month of pregnancy and suffering, Stephanie Rosell went to the ER after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had assembled in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and vomited.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”

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 plan her recovery and give birth.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the leg infection was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie had a baby girl weighing just over four pounds – born before term, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been given four hours before delivery.

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

Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she relapsed. She felt worthless, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her source would not provide to her when she became obviously with child.

“However, I failed,” she said. “I had to seek support.”

The widespread belief that her love for her baby would make her quit only led to deeper self-loathing and negative self-talk, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The baby was taken to the NICU. When Stephanie at last met her, she was attached to monitors, so little she thought she would break her. Cradling her initially, she felt empty. “I just stared at 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 give her child the name Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is proving a simple point: when families are kept intact, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, care providers came to bring her to the facility.

She left the medical center still in withdrawal, fearful and unsure about what would follow.

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At the facility, Stephanie still feared that child services would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could walk in and separate them.

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

Survival outdoors, she said, was about survival. Addiction came first; trust came last.

Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to value herself, let alone anyone else.

Daily, staff from the center took her to a recovery program, given as medication. Slowly, she was starting to get clean.

She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an occupational therapist – all typical problems for babies born with NAS.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. An advocate, a recovery coach, stopped by with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor 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. None of those things mattered to them.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her lap for the children to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could be a mom.”

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

The evaluation method was created in 1975|