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Pregnant and experiencing intense discomfort, Stephanie Rosell visited the ER after her infection worsened up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and vomited.

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to plan her recovery and give birth.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

A short time later, on the 12th of November, Stephanie had a daughter weighing 4lb 8oz – early, tiny yet healthy.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been given shortly before she gave birth.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she relapsed. She felt without value, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “just” 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 bond with her newborn would make her recover only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie at last met her, she was hooked up to monitors, so tiny she thought she would break her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to give her child the name Izzie, after the professional who provided support to her.

Nurses and doctors told her about Maddie’s Place, a new kind of care center where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a small, growing network of centers like this facility is proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to bring her to the facility.

She departed the institution still in recovery, fearful and unsure about what would come next.

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At Maddie’s Place, Stephanie still worried that CPS would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any point, someone could arrive and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about getting by. Substances came first; reliance came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to love herself, not to mention anyone else.

Daily, staff from the center transported her to a clinic for methadone, provided orally. Gradually, she was starting to get clean.

She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an specialist – all frequent conditions for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. A support specialist, a peer support specialist, stopped by with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a pompom on her head, seated on the ground 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 lap for the children to see and they are crowding near, showing interest to the baby.

One child, eight, asked the moms: “Where are all the dads?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I would become a mother.”

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Methods to address babies with exposure have existed for decades.

The assessment tool was created in 1975|