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In her eighth month of pregnancy and suffering, a woman named Stephanie went to the ER after her infection worsened 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 addicted to fentanyl.

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

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had just enough time to get treated before she had to return to get high again. She thought she still had a month remaining to find a way to become sober and give birth.

The medical professional intervened. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

After five days, on a day in November 2022, Stephanie had a baby girl weighing just over four pounds – born before term, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her final administration of fentanyl had been provided a few hours prior to birth.

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

Stephanie had sought recovery multiple times while expecting, and felt awful each time she relapsed. She felt worthless, blaming herself for not being able to do the impossible. An obstetrician told her to “simply” 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 stop using only led to deeper self-loathing and self-harm, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

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

Medical personnel told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like the care home is proving a simple point: when mothers and babies stay together, results get better, foster placements fall and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to pick her up.

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

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At the care center, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could walk in and separate them.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”

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

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to hurt her. She did not know how to love herself, much less anyone else.

Daily, staff from the center drove her to a treatment center, administered in pill form. Over time, she was embracing sobriety.

She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an specialist – all frequent conditions for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I could parent.

On a day prior to the holiday, Stephanie remained in the shared space, 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 drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a pompom on her head, resting on the floor with the door behind her. She is thin. Her head is tilted forward so you cannot see her face. She is lifting the baby on her lap for the young ones to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the parents: “Why are there no men?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if possible.

“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I could be a mom.”

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

The Finnegan NAS scale was created in 1975|