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In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at 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 built in a acquaintance's garden. She was also dependent on fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She slumped forward and threw up.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had just enough time to get treated before she had to return to get high again. She thought she still had a month remaining to find a way to become sober and have this baby.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

A short time later, on the 12th of November, Stephanie delivered a daughter weighing just over four pounds – early, little but surviving.

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

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she relapsed. She felt hopeless, berating herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier refused to sell to her when she became clearly expecting.

“But I couldn’t,” she said. “I needed help.”

The widespread belief that her bond with her newborn would make her stop using only led to greater shame and negative self-talk, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the NICU. When Stephanie at last met her, she was hooked up to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

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

Medical personnel told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and medicated 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, results get better, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, care providers came to collect her.

She left the medical center still in withdrawal, scared and uncertain about what would follow.

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At the facility, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could arrive and separate them.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about survival. Substances came first; reliance came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to let her down. She was unable to value herself, much less anyone else.

Every day, staff from Maddie’s Place took her to a treatment center, provided orally. Slowly, she was starting to get clean.

She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I could be a mom.

During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a peer support specialist, stopped by with her own family in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her posture is humble so you cannot see her face. She is holding Izzie up on her lap for the other kids to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the parents: “Where are all the dads?” The parents responded that the dads were busy, 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 her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could parent.”

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Approaches for managing infants affected by substances have been available for years.

The evaluation method was created in 1975|