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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the ER after an infection began spreading up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had built in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and became sick.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”

She had used fentanyl before arriving at the hospital and had just enough time to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and deliver her child.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.

After five days, on a day in November 2022, Stephanie had a baby girl weighing 4lb 8oz – born before term, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.

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

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she relapsed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

“However, I failed,” she said. “I needed help.”

The pervasive expectation that her love for her baby would make her stop using only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.

The baby was taken to the NICU. When Stephanie finally saw her her, she was connected to monitors, so small she thought she would break her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter the same as her nurse, after the nurse who had been so kind to her.

Nurses and doctors told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) 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 this facility is proving a simple point: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to collect her.

She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.

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At the facility, Stephanie still feared that CPS would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could arrive and take her baby away.

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

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

Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to cause pain. She was unable to value herself, let alone anyone else.

Each day, staff from the center took her to a clinic for methadone, given as medication. Over time, she was embracing sobriety.

She spent every minute 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 adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all typical problems 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 guided meetings with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe 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 keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a beanie 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 lifting the baby on her leg for the children to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if they could.

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

Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I would become a mother.”

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Methods to address infants affected by substances have been available for years.

The evaluation method was established in 1975|