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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. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also addicted to fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She slumped forward and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had only a brief window to get treated before she had to return to get high again. She thought she still had four weeks left to figure out how to get clean and give birth.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie gave birth to a daughter weighing just over four pounds – premature, tiny yet healthy.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.

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

Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she failed. She felt hopeless, berating herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her source would not provide to her when she became visibly pregnant.

“Yet I was unable,” she said. “I needed help.”

The common assumption that her love for her baby would make her recover only led to greater shame and self-abuse, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.

The baby was taken to the special care nursery. When Stephanie eventually visited her, she was connected to monitors, so little she thought she would hurt her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

After two days she decided to name her baby 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 parents and infants affected by substance use are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a small, growing network of centers like the care home is showing an important truth: when families are kept intact, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She stepped out of the hospital still in recovery, scared and uncertain about what would happen next.

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At the facility, Stephanie still was concerned that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could walk in and remove her child.

For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

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

Stephanie had a single companion, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She did not know how to love herself, much less anyone else.

Every day, staff from the center transported her to a recovery program, provided orally. Over time, she was beginning recovery.

She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all typical problems for babies exposed to substances.

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

On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a peer support specialist, stopped by with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a bobble on her head, resting on the floor with the entryway at her back. She is slender. Her posture is humble so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are crowding near, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”

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 could parent.”

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Tools for treating drug-exposed newborns have been available for years.

The assessment tool was developed in 1975|