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Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had assembled in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. 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 coming to the ER and had only a brief window to get treated before she needed to go home to use once more. 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 staying put.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but medical staff detected she also had an ruptured membrane. 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 regulated amounts of fentanyl every few hours, 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 frequently utilized in rehabilitation.

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

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her final administration of fentanyl had been administered shortly before she gave birth.

She felt unwell. Ill-equipped for parenting. Unworthy.

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source declined to supply to her when she became clearly expecting.

“Yet I was unable,” she said. “I required assistance.”

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 relapse. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the special care nursery. When Stephanie eventually visited her, she was connected to medical equipment, so small she thought she would hurt her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to name her baby after her caregiver, after the nurse who had been so kind to her.

Nurses and doctors told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is found to have infant withdrawal condition frequently, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a developing system of centers like this facility is demonstrating a key fact: when parents and infants remain united, recovery succeeds, 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, a couple of employees came to pick her up.

She left the medical center still in detox, anxious and doubtful about what would happen next.

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At the facility, Stephanie still was concerned that authorities would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and separate them.

For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Homelessness, she said, was about getting by. Substances came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to cause pain. She lacked the ability to love herself, let alone anyone else.

Each day, staff from the center transported her to a clinic for methadone, given as medication. Slowly, she was starting to get clean.

She devoted all her time outside treatment 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 obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all frequent conditions for babies affected by withdrawal.

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

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. An advocate, a peer support specialist, visited with her own children in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She has an image of the moment. She is clad in casual attire, a cap with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her knee for the other kids to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if they could.

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

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could be a mom.”

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Approaches for managing infants affected by substances have been available for years.

The evaluation method was created in 1975|