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Eight months pregnant and in severe pain, Stephanie Rosell went to the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”

She had taken the drug before seeking medical help and had just enough time to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and have this baby.

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

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the leg infection was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, 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 rehabilitation.

A short time later, on the 12th of November, Stephanie delivered a infant weighing just over four pounds – premature, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been given a few hours prior to birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her supplier would not provide to her when she became obviously with child.

“Yet I was unable,” she said. “I had to seek support.”

The common assumption that her bond with her newborn would make her stop using only led to deeper self-loathing and negative self-talk, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to tubes and leads, so little she thought she would harm her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about a care center, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a developing system of centers like this facility is proving a simple point: when families are kept intact, results get better, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to collect her.

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

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

For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about enduring. Addiction came first; trust came last.

Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She lacked the ability to care for herself, let alone anyone else.

Each day, staff from the facility drove her to a treatment center, given as medication. Slowly, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an specialist – all typical problems 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.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a cap with a decoration on her head, sitting on the wooden floor with the exit nearby. She is thin. Her head is tilted forward so you miss her features. She is holding Izzie up on her lap for the children to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, called away to other tasks, that they would be there if they could.

“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I would become a mother.”

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Approaches for managing infants affected by substances have been used for a long time.

The Finnegan NAS scale was established in 1975|