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Pregnant and experiencing intense discomfort, Stephanie Rosell went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and vomited.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl 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 deliver her child.

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

“I will go,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but physicians found 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 regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

Five days later, on a day in November 2022, Stephanie gave birth to a baby girl weighing a small weight – early, tiny yet healthy.

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

She felt unwell. Ill-equipped for parenting. Not fit.

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her dealer would not provide to her when she became obviously with child.

“But I couldn’t,” she said. “I needed help.”

The widespread belief that her bond with her newborn would make her quit only led to increased guilt and self-abuse, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was attached to monitors, so tiny she thought she would harm her. Holding her for the first time, she felt nothing. “I gazed upon 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 professional who provided support to her.

Hospital staff told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is diagnosed with infant withdrawal condition frequently, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, results get better, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, two staff members came to bring her to the facility.

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

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At the facility, Stephanie still was concerned that CPS would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could arrive and separate them.

For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about survival. Drugs came first; reliance came last.

Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to cause pain. She did not know how to value herself, let alone anyone else.

Each day, staff from the center transported her to a clinic for methadone, given as medication. Over time, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all common issues for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, stopped by with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The young ones stared in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing black pants and a hoodie, a beanie with a bobble on her head, sitting on the wooden floor with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the mothers: “Where are all the dads?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there given the chance.

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

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could be a mom.”

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Approaches for managing babies with exposure have been available for years.

The assessment tool was developed in 1975|