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Pregnant and experiencing intense discomfort, the expectant mother arrived at the medical facility after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she lived in a shed she had constructed in a companion's property. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and became sick.

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

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had several weeks to find a way to become sober and deliver her child.

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

“I will go,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.

Five days later, on the 12th of November, Stephanie gave birth to a infant weighing a small weight – born before term, tiny yet healthy.

When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been administered shortly before she gave birth.

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

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she failed. She felt hopeless, criticizing herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her source would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I needed help.”

The widespread belief that her affection for her child would make her recover 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 persistent condition.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so little she thought she would harm her. Embracing her at last, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

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

Medical personnel told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a small, growing network of centers like the care home is proving a simple point: when parents and infants remain united, 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, a couple of employees came to bring her to the facility.

She stepped out of the hospital still in withdrawal, anxious and doubtful about what would follow.

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At the facility, Stephanie still was concerned that CPS would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could enter and separate them.

For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about survival. Addiction came first; reliance 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 lacked the ability to value herself, let alone anyone else.

Daily, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Gradually, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all frequent conditions for babies affected by withdrawal.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own five kids in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The young ones stared in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her leg for the young ones to see and they are standing close, fawning and reaching out to the baby.

One child, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if possible.

“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion 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 was able. I could be a mom.”

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Methods to address drug-exposed newborns have been available for years.

The assessment tool was established in 1975|