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Pregnant and experiencing intense discomfort, Stephanie Rosell arrived at the medical facility after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had assembled in a companion's property. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. 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 get high.”

She had used fentanyl 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 several weeks to find a way to become sober and deliver her child.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – born before term, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.

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

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she failed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “simply” stop using. Even her source would not provide to her when she became clearly expecting.

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

The widespread belief that her affection for her child would make her quit only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to monitors, so little she thought she would harm her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Two days later she decided to name her baby the same as her nurse, after the professional who provided support to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to pick her up.

She stepped out of the hospital still in withdrawal, anxious and doubtful about what would happen next.

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At Maddie’s Place, Stephanie still worried that child services would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could walk in and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about survival. Substances came first; trust came last.

Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She lacked the ability to value herself, let alone anyone else.

Each day, staff from Maddie’s Place took her to a recovery program, administered in pill form. Over time, she was starting to get clean.

She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care 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 increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.

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

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a recovery coach, visited with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She holds a picture of the moment. She is clad in casual attire, a gray knit hat with a decoration on her head, seated on the ground with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the children to see and they are crowding near, admiring and touching to the baby.

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

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

Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I could be a mom.”

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Tools for treating drug-exposed newborns have been used for a long time.

The assessment tool was developed in 1975|