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Eight months pregnant and in severe pain, a woman named Stephanie went to the ER after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and vomited.

Stephanie eventually collapsed. “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 needed to go home to get high again. She thought she still had several weeks to find a way to become sober and have this baby.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the leg infection was critical, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.

After five days, on 12 November 2022, Stephanie had a infant weighing just over four pounds – premature, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her epidural had failed, her last dose of fentanyl had been given a few hours prior to birth.

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

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she failed. She felt worthless, blaming herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her dealer declined to supply to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The pervasive expectation that her love for her baby would make her quit only led to deeper self-loathing and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would hurt her. Embracing her at last, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt 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 specialized facility, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is proving a simple point: when mothers and babies stay together, results get better, custody cases decrease and overall savings increase.

It took Stephanie a while to gather the courage 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 withdrawal, anxious and doubtful about what would follow.

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At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could enter and remove her child.

For the beginning period, Stephanie stayed withdrawn. “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 getting by. Substances came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to cause pain. She lacked the ability to care for herself, let alone anyone else.

Every day, staff from the center drove her to a clinic for methadone, provided orally. Over time, she was embracing sobriety.

She devoted all her time when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an specialist – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, visited with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” 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 decoration on her head, sitting on the wooden floor with the door behind her. She is lean. Her face is downcast so you cannot see her face. She is presenting her daughter on her lap for the children to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the parents: “Why are there no men?” The parents responded that the men were occupied, engaged elsewhere, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I found the courage. I could parent.”

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Methods to address drug-exposed newborns have been used for a long time.

The Finnegan NAS scale was created in 1975|