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Eight months pregnant and in severe pain, Stephanie Rosell arrived at the ER after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had constructed in a companion's property. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she needed to go home to get high again. She thought she still had several weeks to figure out how to get clean and deliver her child.

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

“I am leaving,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

After five days, on the 12th of November, Stephanie delivered a infant weighing just over four pounds – early, little but surviving.

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 provided four hours before delivery.

She felt ill. Unprepared to be a mother. Unworthy.

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she failed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her supplier would not provide to her when she became clearly expecting.

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

The common assumption that her bond with her newborn would make her stop using only led to increased guilt and self-harm, a trigger 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 infant was moved to the special care nursery. When Stephanie at last met her, she was attached to tubes and leads, so small she thought she would harm her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to call her daughter the same as her nurse, after the professional who provided support to her.

Medical personnel told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are treated together, not apart.

In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when parents and infants remain united, results get better, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to collect her.

She departed the institution still in detox, fearful and unsure about what would come next.

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At the care center, Stephanie still was concerned that authorities would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could enter and separate them.

For the first two weeks, Stephanie stayed withdrawn. “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 enduring. Addiction came first; reliance came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to cause pain. She lacked the ability to love herself, not to mention anyone else.

Every day, staff from the facility drove her to a recovery program, administered in pill form. Over time, she was embracing sobriety.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a decoration on her head, seated on the ground with the exit nearby. She is slender. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her leg for the children to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if they could.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could be a mom.”

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Tools for treating drug-exposed newborns have been used for a long time.

The Finnegan NAS scale was developed in 1975|