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In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had assembled in a friend’s yard. She was also addicted to fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.

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

She had consumed opioids before seeking medical help and had only a brief window to get treated before she had to return to use once more. She thought she still had several weeks to figure out how to get clean and have this baby.

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

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.

Five days later, on a day in November 2022, Stephanie had a baby girl weighing 4lb 8oz – early, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her pain relief did not work, her last dose of fentanyl had been administered four hours before delivery.

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

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her source refused to sell to her when she became clearly expecting.

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

The widespread belief that her love for her baby would make her recover only led to deeper self-loathing and negative self-talk, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the NICU. When Stephanie eventually visited her, she was connected to medical equipment, so small she thought she would break her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.

Nurses and doctors told her about a care center, a innovative treatment home where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is showing an important truth: when parents and infants remain united, outcomes improve, custody cases decrease and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to pick her up.

She departed the institution still in recovery, fearful and unsure about what would follow.

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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 concern persisted: that at any time, someone could arrive and remove her child.

For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about survival. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She was unable to love herself, let alone anyone else.

Daily, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Over time, she was beginning recovery.

She utilized each moment 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 specialist – all common issues for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. An advocate, a recovery coach, stopped by with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, sitting on the wooden 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 lap for the children to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I could be a mom.”

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Methods to address drug-exposed newborns have existed for decades.

The Finnegan NAS scale was established in 1975|