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Eight months pregnant and in severe pain, Stephanie Rosell visited the medical facility after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she lived in a shed she had assembled in a acquaintance's garden. She was also dependent on fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”

She had used fentanyl before coming to the ER and had just enough time to get treated before she needed to go home to get high again. She thought she still had a month remaining to figure out how to get clean and deliver her child.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was critical, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

After five days, on the 12th of November, Stephanie delivered a infant weighing 4lb 8oz – premature, small but alive.

When the nurse asked if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her epidural had failed, her final administration of fentanyl had been administered a few hours prior to birth.

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

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she was unsuccessful. She felt without value, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her dealer refused to sell to her when she became clearly expecting.

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

The common assumption that her affection for her child would make her recover only led to deeper self-loathing and self-harm, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.

The infant was moved to the NICU. When Stephanie finally saw her her, she was attached to monitors, so tiny she thought she would hurt her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to name her baby Izzie, after the nurse who had been so kind to her.

Nurses and doctors told her about a care center, a new kind of care center where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like the care home is demonstrating a key fact: when families are kept intact, recovery succeeds, custody cases decrease and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to pick her up.

She left the medical center still in detox, fearful and unsure about what would follow.

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At the care center, Stephanie still feared that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and remove her child.

For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about survival. Substances came first; trust came last.

Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She lacked the ability to value herself, not to mention anyone else.

Each day, staff from the center took her to a treatment center, provided orally. Over time, she was starting to get clean.

She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an professional – all common issues 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.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. An advocate, a recovery coach, came over with her own children in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in awe of the little newborn 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 keeps a photo of the moment. She is dressed in black pants and a hoodie, a cap with a bobble on her head, seated on the ground with the door behind her. She is slender. Her head is tilted forward so you miss her features. She is lifting the baby on her leg for the other kids to see and they are gathered around, admiring and touching to the baby.

One child, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“When I have kids,” 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 these babies deserve to be loved, then I could do this. I would become a mother.”

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Approaches for managing babies with exposure have existed for decades.

The evaluation method was developed in 1975|