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Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she resided in a small structure she had constructed in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”

She had taken the drug before arriving at the hospital and had just enough time to get treated before she needed to go home to get high again. She thought she still had several weeks to plan her recovery and have this baby.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

After five days, on the 12th of November, Stephanie had a daughter weighing 4lb 8oz – early, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been administered a few hours prior to birth.

She felt unwell. Unprepared to be a mother. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt awful each time she was unsuccessful. She felt worthless, 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 obviously with child.

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

The pervasive expectation that her affection for her child would make her quit only led to greater shame and negative self-talk, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.

The infant was moved to the special care nursery. When Stephanie finally saw her her, she was hooked up to medical equipment, 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 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 attendant who showed compassion to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care and medicated 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, recovery succeeds, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

She departed the institution still in detox, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still was concerned that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could enter and remove her child.

For the first two weeks, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

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

Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to hurt her. She was unable to value herself, much less anyone else.

Daily, staff from Maddie’s Place took her to a recovery program, administered in pill form. Slowly, she was beginning recovery.

She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.

On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a recovery coach, visited with her own family in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in awe 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 clad in casual attire, a gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast so you cannot see her face. She is presenting her daughter on her knee for the other kids to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I would become a mother.”

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Methods to address drug-exposed newborns have been available for years.

The evaluation method was developed in 1975|