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In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the ER after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also addicted to fentanyl.

As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and vomited.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to plan her recovery and have this baby.

The nurse had other ideas. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was critical, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

After five days, on the 12th of November, Stephanie gave birth to a daughter weighing a small weight – early, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.

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

Stephanie had tried to get clean several times during pregnancy, and felt awful each time she failed. She felt without value, berating herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her bond with her newborn would make her stop using only led to increased guilt and self-abuse, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was connected to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt detached. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.

Nurses and doctors told her about a care center, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is identified with infant withdrawal condition regularly, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when parents and infants remain united, results get better, custody cases decrease and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to collect her.

She left the medical center still in recovery, fearful and unsure about what would come next.

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At Maddie’s Place, Stephanie still worried that child services would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any point, someone could walk in and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about getting by. Drugs came first; reliance came last.

Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to cause pain. She was unable to care for herself, not to mention anyone else.

Daily, staff from Maddie’s Place took her to a recovery program, given as medication. Gradually, she was starting to get clean.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. A support specialist, a recovery coach, visited with her own children in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, sitting on the wooden floor with the door behind her. She is thin. Her posture is humble so you cannot see her face. She is lifting the baby on her leg for the young ones to see and they are standing close, showing interest to the baby.

One child, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if possible.

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

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could parent.”

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Approaches for managing drug-exposed newborns have existed for decades.

The Finnegan NAS scale was developed in 1975|