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Pregnant and experiencing intense discomfort, Stephanie Rosell went to the medical facility after her infection worsened up her legs. Without a job or home, estranged from her family, she lived in a shed she had assembled in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and threw up.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”

She had consumed opioids before seeking medical help and had only a brief window 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 give birth.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

Five days later, on the 12th of November, Stephanie had a infant weighing just over four pounds – early, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been provided a few hours prior to birth.

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

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she failed. She felt worthless, berating herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became visibly pregnant.

“However, I failed,” she said. “I needed help.”

The widespread belief that her affection for her child would make her recover only led to deeper self-loathing and self-abuse, a trigger for her to use again. Yet she could not just wish 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 tubes and leads, so little she thought she would break her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to call her daughter after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about a care center, a unique recovery environment where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, recovery succeeds, fewer children enter care and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.

She departed the institution still in recovery, scared and uncertain about what would follow.

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At the care center, Stephanie still feared that authorities would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could walk in and remove her child.

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

Life on the streets, she said, was about survival. Drugs 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 hurt her. She was unable to care for herself, much less anyone else.

Daily, staff from the center drove her to a clinic for methadone, given as medication. Slowly, she was beginning recovery.

She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an specialist – all frequent conditions for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I could be a mom.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration of the small baby 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 has an image of the moment. She is wearing black pants and a hoodie, a cap with a decoration on her head, seated on the ground with the entryway at her back. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her lap for the children to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there given the chance.

“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 Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could be a mom.”

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Methods to address drug-exposed newborns have been available for years.

The Finnegan NAS scale was created in 1975|