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Pregnant and experiencing intense discomfort, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

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

She had taken the drug before seeking medical help and had only a brief window to get treated before she had to return to use once more. She thought she still had four weeks left to find a way to become sober and deliver her child.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was serious, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.

A short time later, on a day in November 2022, Stephanie delivered a infant weighing a small weight – premature, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been administered four hours before delivery.

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

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she failed. She felt without value, blaming herself for not being able to do the impossible. An obstetrician 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 required assistance.”

The pervasive expectation that her love for her baby would make her recover only led to deeper self-loathing and self-abuse, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the NICU. When Stephanie eventually visited her, she was hooked up to monitors, so tiny she thought she would break her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.

In numerous states, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to pick her up.

She departed the institution still in recovery, fearful and unsure about what would happen next.

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At Maddie’s Place, Stephanie still was concerned that CPS would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could walk in and separate them.

For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”

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

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

Daily, staff from the center transported her to a clinic for methadone, provided orally. Slowly, she was starting to get clean.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I could parent.

During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. An advocate, a mentor, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She holds a picture of the moment. She is clad in casual attire, a gray knit hat with a decoration on her head, resting on the floor with the exit nearby. She is slender. Her posture is humble so you miss her features. She is lifting the baby on her knee for the other kids to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “Why are there no men?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there if they could.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could parent.”

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Approaches for managing infants affected by substances have existed for decades.

The assessment tool was established in 1975|