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Pregnant and experiencing intense discomfort, Stephanie Rosell went to the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had assembled in a friend’s yard. She was also addicted to fentanyl.

As physicians addressed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had four weeks left to figure out how to get clean and give birth.

The medical professional intervened. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, 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 symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.

After five days, on 12 November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – born before term, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been administered a few hours prior to birth.

She felt unwell. Ill-equipped for parenting. Not fit.

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.

“But I couldn’t,” she said. “I needed help.”

The pervasive expectation that her bond with her newborn would make her quit only led to greater shame and self-harm, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the NICU. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would break her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

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

Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition regularly, infants are still rushed to special care and medicated 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, recovery succeeds, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to bring her to the facility.

She left the medical center still in withdrawal, scared and uncertain about what would come next.

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At the care center, Stephanie still feared that authorities would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could walk in and remove her child.

For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about survival. Addiction came first; reliance came last.

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

Every day, staff from the center transported her to a recovery program, provided orally. Slowly, she was embracing sobriety.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies exposed to substances.

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

During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

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

She holds a picture of the moment. She is wearing casual attire, a gray knit hat with a pompom on her head, resting on the floor with the exit nearby. She is thin. Her posture is humble so you miss her features. She is lifting the baby on her lap for the young ones to see and they are gathered around, showing interest to the baby.

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

“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could parent.”

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Approaches for managing babies with exposure have existed for decades.

The Finnegan NAS scale was created in 1975|