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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. Unemployed and homeless, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before coming to the ER and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had several weeks to plan her recovery and deliver her child.

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

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the leg infection was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

After five days, on a day in November 2022, Stephanie had a daughter weighing just over four pounds – premature, small but alive.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been given four hours before delivery.

She felt sick. Ill-equipped for parenting. Undeserving.

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source would not provide to her when she became clearly expecting.

“However, I failed,” she said. “I required assistance.”

The pervasive expectation that her affection for her child would make her stop using only led to increased guilt and self-harm, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.

The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to tubes and leads, so little she thought she would break her. Embracing her at last, she felt nothing. “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 call her daughter Izzie, after the professional who provided support to her.

Medical personnel told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.

In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when mothers and babies stay together, results get better, foster placements fall and future expenses reduce.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to collect her.

She departed the institution still in detox, anxious and doubtful about what would come next.

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At the facility, Stephanie still worried that CPS would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could arrive and remove her child.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about enduring. 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 let her down. She did not know how to value herself, not to mention anyone else.

Each day, staff from the center drove her to a recovery program, administered in pill form. Gradually, she was embracing sobriety.

She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.

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

During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. An advocate, a mentor, visited with her own five kids in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They were innocent,” 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 black pants and a hoodie, a beanie with a decoration on her head, resting on the floor with the exit nearby. She is thin. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her leg for the children to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, 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 her companion made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I would become a mother.”

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Approaches for managing babies with exposure have been used for a long time.

The Finnegan NAS scale was established in 1975|