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In her eighth month of pregnancy and suffering, Stephanie Rosell visited the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and vomited.

Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”

She had consumed opioids before seeking medical help and had just enough time to get treated before she had to return to get high again. She thought she still had a month remaining to plan her recovery and deliver her child.

The medical professional intervened. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

After five days, on 12 November 2022, Stephanie delivered a infant weighing just over four pounds – early, small but alive.

When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been provided four hours before delivery.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she failed. She felt hopeless, blaming herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her supplier declined to supply to her when she became visibly pregnant.

“But I couldn’t,” she said. “I had to seek support.”

The widespread belief that her love for her baby would make her stop using only led to increased guilt and negative self-talk, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to tubes and leads, so tiny she thought she would harm her. Cradling her initially, she felt detached. “I just stared 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 call her daughter after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about Maddie’s Place, a unique recovery environment where women and their babies are supported as a unit, not apart.

In much of the US, where a baby is found to have infant withdrawal condition regularly, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a limited but expanding group of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to collect her.

She left the medical center still in detox, anxious and doubtful about what would come next.

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At the facility, Stephanie still worried that CPS would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could enter and take her baby away.

For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about getting by. Substances came first; reliance came last.

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She lacked the ability to love herself, let alone anyone else.

Each day, staff from the facility transported her to a treatment center, administered in pill form. Slowly, she was embracing sobriety.

She spent every minute outside treatment 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 pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an professional – all typical problems for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a mentor, visited with her own family in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” 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 wearing casual attire, a beanie with a bobble on her head, seated on the ground with the door behind her. She is slender. Her posture is humble so you cannot see her face. She is lifting the baby on her leg for the children to see and they are gathered around, showing interest to the baby.

Jacob, eight, asked the mothers: “Why are there no men?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could be a mom.”

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Methods to address infants affected by substances have existed for decades.

The evaluation method was created in 1975|