🔗 Share this article

Eight months pregnant and in severe pain, Stephanie Rosell arrived at the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had assembled in a companion's property. She was also dependent on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she needed to go home to get high again. She thought she still had a month remaining to plan her recovery and have this baby.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.

Five days later, on a day in November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – early, small but alive.

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

She felt sick. Ill-equipped for parenting. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she relapsed. She felt without value, criticizing herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her source would not provide to her when she became obviously with child.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her bond with her newborn would make her recover only led to increased guilt and negative self-talk, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.

The baby was taken to the NICU. When Stephanie eventually visited her, she was attached to medical equipment, so small she thought she would break her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

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

Nurses and doctors told her about Maddie’s Place, a innovative treatment home where women and their babies are supported as a unit, not apart.

In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when mothers and babies stay together, outcomes improve, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.

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

---

At the care center, Stephanie still worried that CPS would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could walk in and take her baby away.

For the initial fortnight, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about getting by. Drugs came first; faith came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to let her down. She did not know how to care for herself, let alone anyone else.

Each day, staff from the facility transported her to a treatment center, administered in pill form. Over time, she was starting to get clean.

She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an professional – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I could do this. I would become a mother.

One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a recovery coach, came over with her own children in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She keeps a photo of the moment. She is wearing black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is presenting her daughter on her leg for the young ones to see and they are standing close, admiring and touching to the baby.

Jacob, eight, asked the parents: “Why are there no men?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there if possible.

“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 the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could be a mom.”

---

Tools for treating babies with exposure have been used for a long time.

The evaluation method was established in 1975|