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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, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward 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 just enough time to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and give birth.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.

After five days, on 12 November 2022, Stephanie delivered a daughter weighing 4lb 8oz – born before term, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been administered shortly before she gave birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she failed. She felt hopeless, berating herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her source would not provide to her when she became obviously with child.

“But I couldn’t,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her quit only led to increased guilt and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to medical equipment, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘What is our future?’” 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 attendant who showed compassion to her.

Hospital staff told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like this facility is showing an important truth: when families are kept intact, results get better, custody cases decrease and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to bring her to the facility.

She stepped out of the hospital still in withdrawal, fearful and unsure 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 uncertain about motherhood. The fear lingered: that at any point, someone could walk in and separate them.

For the first two weeks, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about survival. Substances came first; trust came last.

Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to hurt her. She was unable to care for herself, much less anyone else.

Each day, staff from the center took her to a recovery program, given as medication. Over time, she was beginning recovery.

She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. An advocate, a peer support specialist, visited with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She has an image of the moment. She is dressed in casual attire, a gray knit hat with a pompom on her head, resting on the floor with the door behind her. She is thin. Her posture is humble so you do not see her expression. She is holding Izzie up on her knee for the children to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if possible.

“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and her companion made eye contact. “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 could be a mom.”

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Approaches for managing babies with exposure have been used for a long time.

The assessment tool was created in 1975|