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Pregnant and experiencing intense discomfort, Stephanie Rosell visited the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and threw up.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had only a brief window 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 staying put.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

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

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was detached. Her pain relief did not work, her final administration of fentanyl had been given four hours before delivery.

She felt sick. Not ready for motherhood. Not fit.

Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she failed. She felt worthless, berating herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

“Yet I was unable,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her stop using only led to greater shame 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 long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was attached to monitors, so small she thought she would break her. Cradling her initially, she felt nothing. “I looked 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 name her baby after her caregiver, after the attendant who showed compassion to her.

Nurses and doctors told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is proving a simple point: when families are kept intact, outcomes improve, fewer children enter care 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, a couple of employees came to pick her up.

She stepped out of the hospital still in recovery, scared and uncertain about what would happen next.

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At Maddie’s Place, Stephanie still worried that CPS would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could arrive and remove her child.

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

Homelessness, she said, was about getting by. Addiction came first; faith came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to cause pain. She was unable to care for herself, not to mention anyone else.

Daily, staff from the facility drove her to a recovery program, given as medication. Gradually, she was embracing sobriety.

She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an specialist – all frequent conditions for babies born with NAS.

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

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. An advocate, a recovery coach, visited with her own children in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The young ones stared in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a pompom on her head, seated on the ground with the door behind her. She is thin. Her posture is humble so you cannot see her face. She is holding Izzie up on her leg for the other kids to see and they are standing close, showing interest to the baby.

One child, eight, asked the mothers: “Where are all the dads?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“In the future,” Jacob said, “I’m going to be the best dad ever. 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 found the courage. I could parent.”

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Tools for treating babies with exposure have been available for years.

The evaluation method was developed in 1975|