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Eight months pregnant and in severe pain, a woman named Stephanie arrived at the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had assembled in a friend’s yard. She was also dependent on fentanyl.

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

Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had just enough time to get treated before she was compelled to leave 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 allowed to leave.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was critical, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

Five days later, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – early, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was detached. Her epidural had failed, her final administration of fentanyl had been given a few hours prior to birth.

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

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she failed. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her supplier declined to supply to her when she became obviously with child.

“However, I failed,” she said. “I required assistance.”

The common assumption that her affection for her child would make her quit 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 newborn was transferred to the NICU. When Stephanie eventually visited her, she was hooked up to tubes and leads, so little she thought she would break her. Embracing her at last, she felt detached. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure 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.

Medical personnel told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.

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At the facility, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could walk in and separate them.

For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to care for herself, not to mention anyone else.

Every day, staff from the center took her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.

She devoted all her time 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 obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an specialist – all typical problems for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, came over with her own five kids in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in awe of the tiny infant 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 has an image of the moment. She is dressed in casual attire, a beanie with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her posture is humble so you do not see her expression. She is holding Izzie up on her knee for the young ones to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, engaged elsewhere, 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 her companion exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I found the courage. I could be a mom.”

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Methods to address babies with exposure have been used for a long time.

The assessment tool was established in 1975|