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Pregnant and experiencing intense discomfort, Stephanie Rosell visited the ER after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had constructed in a friend’s yard. She was also hooked on fentanyl.

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

Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”

She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had four weeks left to plan her recovery and deliver her child.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but doctors had discovered she also had an leakage of amniotic fluid. 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 regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

After five days, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – early, small but alive.

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

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

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she was unsuccessful. 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 would not provide to her when she became visibly pregnant.

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

The common assumption that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

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. Holding her for the first time, she felt nothing. “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.

Following a brief period she decided to call her daughter Izzie, after the professional who provided support to her.

Nurses and doctors told her about a care center, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a small, growing network of centers like this facility is proving a simple point: when families are kept intact, results get better, foster placements fall and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, two staff members came to pick her up.

She departed the institution still in detox, scared and uncertain about what would follow.

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At the care center, Stephanie still was concerned that CPS would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could walk in and take her baby away.

For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about enduring. Addiction came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to hurt her. She lacked the ability to care for herself, let alone anyone else.

Each day, staff from the facility took her to a clinic for methadone, provided orally. Over time, she was starting to get clean.

She spent every minute outside treatment 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 nutritional guidance. She also had heightened sensory issues and required an specialist – all frequent conditions for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for supervised visits with their babies. An advocate, a peer support specialist, stopped by with her own family in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in admiration 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. They focused only on the baby.”

She has an image of the moment. She is wearing casual attire, a gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. She is slender. Her posture is humble so you cannot see her face. She is presenting her daughter on her lap for the children to see and they are gathered around, showing interest to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the dads were busy, called away to other tasks, that they would be there given the chance.

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

Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I would become a mother.”

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Approaches for managing drug-exposed newborns have been available for years.

The evaluation method was developed in 1975|