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In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had built in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and threw up.

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

She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had a month remaining to plan her recovery and deliver her child.

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

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie delivered a infant weighing 4lb 8oz – early, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her epidural had failed, her last dose of fentanyl had been given a few hours prior to birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she relapsed. She felt worthless, berating herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her dealer declined to supply to her when she became obviously with child.

“But I couldn’t,” she said. “I needed help.”

The common assumption that her love for her baby would make her recover only led to deeper self-loathing and self-abuse, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.

The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to medical equipment, so small she thought she would break her. Embracing her at last, 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.

Following a brief period 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 new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In numerous states, where a baby is identified with newborn addiction symptoms regularly, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.

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

She left the medical center still in recovery, fearful and unsure about what would come next.

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At the care center, Stephanie still was concerned that child services would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and remove her child.

For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about survival. Substances came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She was unable to care for herself, much less anyone else.

Daily, staff from the facility took her to a treatment center, provided orally. Slowly, she was beginning recovery.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all common issues for babies exposed to substances.

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

On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a recovery coach, visited with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The young ones stared in awe 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. None of those things mattered to them.”

She holds a picture of the moment. She is clad in casual attire, a gray knit hat with a bobble on her head, resting on the floor with the door behind her. She is thin. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her leg for the young ones to see and they are standing close, showing interest to the baby.

One child, eight, asked the moms: “What about the fathers?” The parents responded that the men were occupied, handling responsibilities, that they would be there if they could.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could parent.”

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Approaches for managing babies with exposure have existed for decades.

The Finnegan NAS scale was developed in 1975|