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Eight months pregnant and in severe pain, Stephanie Rosell arrived at the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had built in a acquaintance's garden. She was also hooked on fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and became sick.

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to find a way to become sober and give birth.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the leg infection was critical, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.

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

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been provided shortly before she gave birth.

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

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

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

The common assumption that her love for her baby would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.

The infant was moved to the NICU. When Stephanie at last met her, she was attached to tubes and leads, so little she thought she would hurt her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to give her child the name after her caregiver, after the professional who provided support to her.

Hospital staff told her about a care center, a innovative treatment home where women and their babies are cared for jointly, not apart.

In many parts of America, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, results get better, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, two staff members came to collect her.

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

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At Maddie’s Place, Stephanie still feared that CPS would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could arrive and remove her child.

For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about getting by. Drugs came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to let her down. She did not know how to love herself, not to mention anyone else.

Every day, staff from Maddie’s Place transported her to a treatment center, given as medication. Slowly, she was beginning recovery.

She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an specialist – all typical problems for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She has an image of the moment. She is dressed in black pants and a hoodie, a cap with a decoration on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her lap for the children to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the parents: “What about the fathers?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if possible.

“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith 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 could be a mom.”

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Tools for treating drug-exposed newborns have been available for years.

The assessment tool was established in 1975|