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Eight months pregnant and in severe pain, Stephanie Rosell went to the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had built in a companion's property. She was also hooked on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and became sick.

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

She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to plan her recovery and have this baby.

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 condition in her limbs was critical, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.

After five days, on the 12th of November, Stephanie delivered a baby girl weighing a small weight – premature, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been provided four hours before delivery.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she failed. She felt without value, blaming herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her source would not provide to her when she became visibly pregnant.

“However, I failed,” 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 cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.

The newborn was transferred to the NICU. When Stephanie at last met her, she was attached to medical equipment, so small she thought she would hurt her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to give her child the name the same as her nurse, after the nurse who had been so kind 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 found to have newborn addiction symptoms regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like the care home is proving a simple point: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to collect her.

She left the medical center still in detox, scared and uncertain about what would happen next.

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At the care center, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could enter and remove her child.

For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, 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 let her down. She was unable to love herself, not to mention anyone else.

Daily, staff from the center took her to a treatment center, given as medication. Over time, she was beginning recovery.

She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies born with NAS.

When a child recognizes these infants need affection, then I was capable. I could parent.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. A support specialist, a mentor, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, sitting on the wooden floor with the door behind her. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her leg for the other kids to see and they are gathered around, showing interest to the baby.

One child, eight, asked the moms: “What about the fathers?” The parents responded that the men were occupied, 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 exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could be a mom.”

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Tools for treating babies with exposure have been used for a long time.

The evaluation method was developed in 1975|