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Pregnant and experiencing intense discomfort, the expectant mother went to the medical facility after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”

She had taken the drug before coming to the ER and had only a brief window to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober 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 hospital refused to discharge her: the infection in her legs was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.

A short time later, on the 12th of November, Stephanie delivered a infant weighing a small weight – early, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.

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

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she failed. She felt worthless, berating herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier declined to supply to her when she became obviously with child.

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

The pervasive expectation that her bond with her newborn would make her recover only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.

The infant was moved to the NICU. When Stephanie eventually visited her, she was connected to monitors, so little she thought she would harm her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

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

Medical personnel told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition regularly, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like the care home is proving a simple point: when mothers and babies stay together, outcomes improve, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, two staff members came to bring her to the facility.

She stepped out of the hospital still in withdrawal, anxious and doubtful about what would follow.

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At the facility, Stephanie still worried that authorities would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could walk in and remove her child.

For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about survival. Drugs came first; reliance came last.

Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to hurt her. She was unable to value herself, let alone anyone else.

Daily, staff from the facility transported her to a clinic for methadone, given as medication. Over time, she was starting to get clean.

She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an professional – all frequent conditions for babies affected by withdrawal.

When a child recognizes these infants need affection, then I could do this. I could parent.

One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She has an image of the moment. She is clad in black pants and a hoodie, a gray knit hat with a decoration on her head, sitting on the wooden floor with the door behind her. She is thin. Her face is downcast so you miss her features. She is lifting the baby on her leg for the other kids to see and they are crowding near, fawning and reaching out to the baby.

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

“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could be a mom.”

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Approaches for managing drug-exposed newborns have been used for a long time.

The assessment tool was established in 1975|