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Pregnant and experiencing intense discomfort, the expectant mother visited the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and became sick.

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

She had used fentanyl before coming to the ER and had just enough time to get treated before she needed to go home to use once more. She thought she still had a month remaining to plan her recovery and deliver her child.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she departed, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – born before term, small but alive.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been administered a few hours prior to birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her supplier would not provide to her when she became visibly pregnant.

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

The pervasive expectation that her bond with her newborn would make her quit only led to increased guilt and self-harm, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to tubes and leads, so little she thought she would hurt her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

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

Hospital staff told her about a care center, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like the care home is proving a simple point: when mothers and babies stay together, results get better, custody cases decrease and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, two staff members came to bring her to the facility.

She departed the institution still in recovery, scared and uncertain about what would happen next.

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At Maddie’s Place, Stephanie still feared that authorities would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could arrive and separate them.

For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about getting by. Addiction came first; reliance came last.

Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to cause pain. She did not know how to care for herself, much less anyone else.

Every day, staff from the facility drove her to a recovery program, given as medication. Slowly, she was embracing sobriety.

She utilized each moment 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 intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues 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 could do this. I could be a mom.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. An advocate, a recovery coach, stopped by with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in admiration 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 holds a picture 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 entryway at her back. She is lean. Her posture is humble so you cannot see her face. She is holding Izzie up on her lap for the other kids to see and they are standing close, fawning and reaching out to the baby.

A young boy, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there given the chance.

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

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”

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Tools for treating babies with exposure have been available for years.

The Finnegan NAS scale was established in 1975|