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In her eighth month of pregnancy and suffering, Stephanie Rosell arrived at the ER after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had built in a companion's property. She was also dependent on fentanyl.

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

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had four weeks left to plan her recovery and have this baby.

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

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection 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 be at risk of death.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

A short time later, on a day in November 2022, Stephanie had 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 numb. Her anesthesia was ineffective, her previous intake of fentanyl had been provided a few hours prior to birth.

She felt ill. Ill-equipped for parenting. Undeserving.

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her supplier refused to sell to her when she became visibly pregnant.

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

The common assumption that her affection for her child would make her quit only led to greater shame and self-abuse, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would hurt her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to name her baby after her caregiver, after the attendant who showed compassion to her.

Medical personnel told her about a care center, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is proving a simple point: when mothers and babies stay together, outcomes improve, custody cases decrease and overall savings increase.

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

She stepped out of the hospital still in recovery, fearful and unsure about what would follow.

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At the care center, Stephanie still feared that authorities would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could walk in and remove her child.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about getting by. Drugs came first; trust came last.

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to let her down. She lacked the ability to value herself, let alone anyone else.

Every day, staff from the facility transported her to a clinic for methadone, given as medication. Slowly, she was embracing sobriety.

She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an specialist – all common issues for babies born with NAS.

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

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in admiration 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. None of those things mattered to them.”

She keeps a photo of the moment. She is clad in casual attire, a cap with a pompom on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her knee for the young ones to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if they could.

“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could be a mom.”

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Methods to address babies with exposure have existed for decades.

The Finnegan NAS scale was developed in 1975|