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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. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also addicted to fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and became sick.

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

She had consumed opioids before seeking medical help and had just enough time to get treated before she needed to go home to get high again. She thought she still had a month remaining to figure out how to get clean and give birth.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.

She encouraged 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 medication that eases withdrawal and is frequently utilized in addiction recovery.

Five days later, on 12 November 2022, Stephanie delivered a infant weighing a small weight – born before term, small but alive.

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

She felt ill. Not ready for motherhood. Not fit.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to do the impossible. An obstetrician 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 required assistance.”

The pervasive expectation that her bond with her newborn would make her recover only led to deeper self-loathing and self-harm, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would hurt her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to name her baby 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 mothers and their drug-exposed newborns are treated together, not apart.

In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. 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, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to pick her up.

She departed the institution still in recovery, fearful and unsure about what would follow.

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At the facility, Stephanie still feared that child services would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could enter and take her baby away.

For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”

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

Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to cause pain. She was unable to value herself, not to mention anyone else.

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

She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an specialist – all frequent conditions for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for guided meetings with their babies. A support specialist, a mentor, came over with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She holds a picture of the moment. She is wearing casual attire, a beanie with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her face is downcast so you do not see her expression. She is holding Izzie up on her knee for the other kids to see and they are gathered around, admiring and touching to the baby.

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

“When I have kids,” 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 these babies deserve to be loved, then I found the courage. I could be a mom.”

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Approaches for managing infants affected by substances have been available for years.

The assessment tool was developed in 1975|