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In her eighth month of pregnancy and suffering, Stephanie Rosell went to the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also dependent on fentanyl.

As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and became sick.

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

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 several weeks to plan her recovery and have this baby.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was critical, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.

A short time later, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – early, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.

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

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her source declined to supply to her when she became clearly expecting.

“However, I failed,” she said. “I required assistance.”

The widespread belief that her bond with her newborn would make her recover only led to deeper self-loathing 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 chronic disease.

The infant was moved to the special care nursery. When Stephanie at last met her, she was hooked up to monitors, so tiny she thought she would harm her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

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

Hospital staff told her about a care center, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a developing system of centers like this facility is proving a simple point: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. 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 follow.

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At the care center, Stephanie still feared that CPS would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could enter and remove her child.

For the initial fortnight, Stephanie remained isolated. “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.”

Survival outdoors, she said, was about getting by. Substances came first; trust came last.

Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to cause pain. She did not know how to value herself, much less anyone else.

Every day, staff from the center took her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.

She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an professional – all frequent conditions for babies affected by withdrawal.

When a child recognizes these infants need affection, then I found the strength. I could be a mom.

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. Katie Bunch-Smith, a recovery coach, stopped by with her own family in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you do not see her expression. She is lifting the baby on her lap for the other kids to see and they are standing close, fawning and reaching out to the baby.

One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if they could.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.”

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Tools for treating infants affected by substances have existed for decades.

The evaluation method was established in 1975|