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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had assembled in a friend’s yard. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and vomited.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had a month remaining to plan her recovery and give birth.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection 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 not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

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

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her epidural had failed, her final administration of fentanyl had been administered shortly before she gave birth.

She felt unwell. Ill-equipped for parenting. Unworthy.

Stephanie had attempted sobriety multiple times while expecting, 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 “only” stop using. Even her source refused to sell to her when she became obviously with child.

“However, I failed,” she said. “I required assistance.”

The common assumption that her bond with her newborn would make her recover only led to greater shame and negative self-talk, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to monitors, so little she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

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

Hospital staff told her about a care center, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is identified with newborn addiction symptoms regularly, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a developing system of centers like the care home is showing an important truth: when families are kept intact, results get better, foster placements fall and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to collect her.

She departed the institution still in withdrawal, anxious and doubtful about what would come next.

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At Maddie’s Place, Stephanie still feared that authorities would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could enter and remove her child.

For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about enduring. Drugs came first; trust came last.

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to love herself, much less anyone else.

Every day, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Slowly, she was starting to get clean.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an specialist – all typical problems for babies born with NAS.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, stopped by with her own five kids 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 small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a decoration on her head, seated on the ground with the entryway at her back. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her lap for the children to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if possible.

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could parent.”

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Methods to address babies with exposure have been used for a long time.

The evaluation method was established in 1975|