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In her eighth month of pregnancy and suffering, Stephanie Rosell went to the ER 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 constructed in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and vomited.

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

She had taken the drug before coming to the ER and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to find a way to become sober and deliver her child.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was critical, 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 be at risk of death.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth 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 just over four pounds – born before term, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been given four hours before delivery.

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

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she relapsed. She felt worthless, blaming herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her dealer declined to supply to her when she became visibly pregnant.

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

The widespread belief that her affection for her child would make her stop using only led to increased guilt and self-abuse, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was hooked up to monitors, so tiny she thought she would hurt her. Cradling her initially, she felt detached. “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.

Two days later she decided to name her baby Izzie, after the professional who provided support to her.

Nurses and doctors told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.

In numerous states, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to pick her up.

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

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At the care center, Stephanie still feared that CPS would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “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 survival. Substances came first; reliance came last.

Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to let her down. She did not know how to care for herself, not to mention anyone else.

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

She utilized each moment 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 intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an specialist – all common issues for babies exposed to substances.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a mentor, stopped by with her own children in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She has an image of the moment. She is wearing black pants and a hoodie, 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 do not see her expression. She is lifting the baby on her lap for the young ones to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the parents: “Why are there no men?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if they could.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could parent.”

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Approaches for managing infants affected by substances have been used for a long time.

The assessment tool was established in 1975|