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In her eighth month of pregnancy and suffering, Stephanie Rosell went to the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had built in a companion's property. She was also dependent on fentanyl.

As doctors treated her infection, she began to panic. The onset of withdrawal began. She slumped forward and threw up.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had just enough time to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober and give birth.

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

“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 ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten 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 rehabilitation.

Five days later, on the 12th of November, Stephanie gave birth to a baby girl weighing 4lb 8oz – early, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her epidural had failed, her last dose of fentanyl had been provided four hours before delivery.

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

Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her supplier declined to supply to her when she became obviously with child.

“But I couldn’t,” she said. “I required assistance.”

The pervasive expectation that her love for her baby would make her quit only led to increased guilt and self-harm, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to monitors, so tiny she thought she would hurt her. Embracing her at last, she felt empty. “I just stared 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 give her child the name Izzie, after the attendant who showed compassion to her.

Medical personnel told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when mothers and babies stay together, outcomes improve, fewer children enter care and overall savings increase.

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

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

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At the facility, Stephanie still feared that CPS would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any point, someone could walk in and take her baby away.

For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about enduring. Substances came first; faith came last.

Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to cause pain. She was unable to love herself, much less anyone else.

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

She utilized each moment 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 obvious stomach troubles. She needed dietary support. 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 would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She holds a picture of the moment. She is wearing casual attire, a beanie with a decoration on her head, sitting on the wooden floor with the door behind her. She is thin. 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 standing close, showing interest to the baby.

Jacob, eight, asked the mothers: “Where are all the dads?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there if possible.

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

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I would become a mother.”

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Methods to address infants affected by substances have existed for decades.

The Finnegan NAS scale was developed in 1975|