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Eight months pregnant and in severe pain, Stephanie Rosell went to the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had constructed in a companion's property. She was also dependent on fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and vomited.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before seeking medical help and had only a brief window 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 attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but physicians found she also had an ruptured membrane. The nurse, Izzie, 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 every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie gave birth to a daughter weighing a small weight – premature, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her last dose of fentanyl had been administered four hours before delivery.

She felt unwell. Ill-equipped for parenting. Undeserving.

Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her supplier would not provide to her when she became visibly pregnant.

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

The common assumption that her affection for her child would make her recover only led to increased guilt and self-abuse, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.

The infant was moved to the NICU. When Stephanie at last met her, she was hooked up to monitors, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

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

Medical personnel told her about a care center, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like the care home is proving a simple point: when parents and infants remain united, outcomes improve, foster placements fall and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to pick her up.

She stepped out of the hospital still in recovery, fearful and unsure about what would come next.

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At the care center, Stephanie still feared that child services would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, 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 didn’t have a lot of trust at that point.”

Life on the streets, she said, was about enduring. Substances came first; trust came last.

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to cause pain. She was unable to love herself, much less anyone else.

Each day, staff from the facility took her to a treatment center, given as medication. Slowly, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all typical problems for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for supervised visits with their babies. An advocate, a mentor, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She holds a picture of the moment. She is clad in casual attire, a cap with a decoration on her head, seated on the ground with the entryway at her back. She is thin. Her posture is humble so you do not see her expression. She is holding Izzie up on her knee for the other kids to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could be a mom.”

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Approaches for managing infants affected by substances have been used for a long time.

The evaluation method was created in 1975|