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In her eighth month of pregnancy and suffering, Stephanie Rosell went to the medical facility after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had built in a companion's property. She was also hooked 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. “I have to get out of here. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had only a brief window to get treated before she needed to go home to use once more. She thought she still had four weeks left to plan her recovery and give birth.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the leg infection was severe, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.

Izzie persuaded 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 often prescribed in rehabilitation.

After five days, on 12 November 2022, Stephanie delivered a daughter weighing 4lb 8oz – born before term, tiny yet healthy.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been given a few hours prior to birth.

She felt ill. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she failed. She felt hopeless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her source would not provide to her when she became obviously with child.

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

The widespread belief that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.

The baby was taken to the special care nursery. When Stephanie eventually visited her, she was hooked up to medical equipment, so little she thought she would harm her. Cradling her initially, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

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

Nurses and doctors told her about a care center, a unique recovery environment where women and their babies are cared for jointly, not apart.

In numerous states, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like the care home is proving a simple point: when families are kept intact, outcomes improve, 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 verifying her eligibility for the program, two staff members came to collect her.

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

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At the facility, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could enter and take her baby away.

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

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

Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She was unable to love herself, not to mention anyone else.

Each day, staff from the center drove her to a treatment center, administered in pill form. Gradually, she was beginning recovery.

She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention 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 occupational therapist – all frequent conditions for babies born with NAS.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. An advocate, a recovery coach, visited with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in awe of the small baby in Stephanie’s arms. “They were innocent,” 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 cap with a decoration on her head, seated on the ground with the door behind her. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her knee for the other kids to see and they are standing close, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “Where are all the dads?” The parents responded that the men were occupied, engaged elsewhere, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could parent.”

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

The assessment tool was developed in 1975|