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Pregnant and experiencing intense discomfort, Stephanie Rosell went to the medical facility 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 acquaintance's garden. She was also addicted to fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”

She had taken the drug before coming to the ER and had just enough time to get treated before she needed to go home to relapse. She thought she still had a month remaining to plan her recovery and deliver her child.

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

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.

A short time later, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – early, small but alive.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her epidural had failed, her last dose of fentanyl had been provided a few hours prior to birth.

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

Stephanie had sought recovery multiple times while expecting, and felt horrible each time she relapsed. She felt without value, blaming herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her dealer declined to supply to her when she became obviously with child.

“But I couldn’t,” she said. “I required assistance.”

The pervasive expectation that her bond with her newborn would make her stop using only led to greater shame and self-harm, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the NICU. When Stephanie eventually visited her, she was hooked up to monitors, so tiny she thought she would hurt her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to give her child the name the same as her nurse, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a new kind of care center 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 rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. 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 a period to find strength to call, but she finally did. After verifying her eligibility for the program, care providers came to bring her to the facility.

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

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At Maddie’s Place, Stephanie still was concerned that CPS would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any time, someone could enter and take her baby away.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

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

Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to hurt her. She was unable to value herself, much less anyone else.

Daily, staff from the center transported her to a treatment center, given as medication. Over time, she was starting to get clean.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies born with NAS.

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

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own family in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is wearing black pants and a hoodie, a beanie with a pompom on her head, sitting on the wooden floor with the exit nearby. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her lap for the children to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if they could.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I would become a mother.”

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Tools for treating drug-exposed newborns have been used for a long time.

The assessment tool was established in 1975|