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Pregnant and experiencing intense discomfort, the expectant mother visited the ER 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 dependent on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

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

She had used fentanyl before arriving at the hospital and had just enough time to get treated before she had to return to relapse. She thought she still had four weeks left to figure out how to get clean and have this baby.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was serious, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – early, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been administered four hours before delivery.

She felt unwell. Unprepared to be a mother. Undeserving.

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she was unsuccessful. She felt without value, blaming herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her source refused to sell to her when she became obviously with child.

“Yet I was unable,” she said. “I needed help.”

The widespread belief that her love for her baby would make her recover only led to increased guilt and self-abuse, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The infant was moved to the special care nursery. When Stephanie finally saw her 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 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 supported as a unit, not apart.

In numerous states, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, foster placements fall and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to collect her.

She departed the institution still in withdrawal, anxious and doubtful about what would happen next.

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At the care center, Stephanie still was concerned that child services 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 take her baby away.

For the beginning period, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

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

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to care for herself, much less anyone else.

Every day, staff from the facility took her to a clinic for methadone, given as medication. Over time, she was beginning recovery.

She utilized each moment outside treatment 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 nutritional guidance. She also had increased sensitivity and required an specialist – all frequent conditions for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I could be a mom.

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. A support specialist, a recovery coach, visited with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She has an image of the moment. She is dressed in black pants and a hoodie, a cap with a decoration on her head, resting on the floor with the door behind her. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the other kids to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could parent.”

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Tools for treating drug-exposed newborns have been available for years.

The evaluation method was created in 1975|