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Eight months pregnant and in severe pain, Stephanie Rosell went to the medical facility after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also hooked on fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and became sick.

Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to plan her recovery and have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

Five days later, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – born before term, little but surviving.

When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been given four hours before delivery.

She felt sick. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she failed. She felt worthless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her supplier would not provide to her when she became obviously with child.

“But I couldn’t,” she said. “I required assistance.”

The common assumption that her affection for her child would make her recover only led to greater shame and self-abuse, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.

The infant was moved to the special care nursery. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to give her child the name the same as her nurse, after the nurse who had been so kind to her.

Nurses and doctors told her about a specialized facility, 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 identified with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like the care home is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to pick her up.

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

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At the care center, Stephanie still worried that child services would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could walk in and take her baby away.

For the first two weeks, Stephanie remained isolated. “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. Drugs came first; reliance came last.

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She did not know how to love herself, much less anyone else.

Daily, staff from Maddie’s Place drove her to a recovery program, administered in pill form. Slowly, she was embracing sobriety.

She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an professional – all frequent conditions for babies born with NAS.

When a child recognizes these infants need affection, then I could do this. I could parent.

On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, came over with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed 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 holds a picture of the moment. She is wearing casual attire, a cap with a bobble on her head, resting on the floor with the exit nearby. She is slender. Her face is downcast so you do not see her expression. She is lifting the baby on her knee for the other kids to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “Why are there no men?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could parent.”

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Tools for treating infants affected by substances have been available for years.

The Finnegan NAS scale was created in 1975|