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In her eighth month of pregnancy and suffering, the expectant mother arrived at the ER after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had constructed in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and threw up.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had consumed opioids before coming to the ER and had only a brief window to get treated before she needed to go home to relapse. She thought she still had a month remaining to figure out how to get clean and have this baby.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie gave birth to a baby girl weighing a small weight – early, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her pain relief did not work, her last dose of fentanyl had been provided shortly before she gave birth.

She felt sick. Ill-equipped for parenting. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her source refused to sell to her when she became obviously with child.

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

The widespread belief that her bond with her newborn would make her recover only led to greater shame and negative self-talk, a trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.

The infant was moved to the NICU. When Stephanie eventually visited 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 am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to give her child the name 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 unique recovery environment where women and their babies are treated together, not apart.

In many parts of America, where a baby is identified with newborn addiction symptoms regularly, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, two staff members came to bring her to the facility.

She departed the institution still in detox, scared and uncertain about what would come next.

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At the facility, Stephanie still was concerned that CPS would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could enter and take her baby away.

For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about enduring. Substances came first; faith came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to value herself, let alone anyone else.

Daily, staff from Maddie’s Place transported her to a recovery program, given as medication. Gradually, she was starting to get clean.

She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an occupational therapist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I found the strength. I could parent.

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, came over with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She holds a picture of the moment. She is wearing casual attire, a cap with a bobble on her head, seated on the ground with the exit nearby. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are gathered around, showing interest to the baby.

One child, eight, asked the parents: “Why are there no men?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I would become a mother.”

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Approaches for managing drug-exposed newborns have existed for decades.

The evaluation method was created in 1975|