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In her eighth month of pregnancy and suffering, the expectant mother went to 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 assembled in a acquaintance's garden. She was also dependent on fentanyl.

As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had several weeks to figure out how to get clean and deliver her child.

The nurse had other ideas. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

A short time later, on 12 November 2022, Stephanie had a baby girl weighing just over four pounds – early, tiny yet healthy.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her epidural had failed, her last dose of fentanyl had been administered four hours before delivery.

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

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she relapsed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her dealer refused to sell to her when she became clearly expecting.

“Yet I was unable,” she said. “I had to seek support.”

The pervasive expectation that her love for her baby would make her recover only led to increased guilt and self-abuse, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to monitors, so small she thought she would harm her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name the same as her nurse, after the professional who provided support to her.

Hospital staff told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In many parts of America, where a baby is identified with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, results get better, foster placements fall and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She left the medical center still in withdrawal, anxious and doubtful about what would happen next.

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At Maddie’s Place, Stephanie still worried that CPS would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any time, someone could walk in and separate them.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” 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; reliance came last.

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to let her down. She did not know how to care for herself, not to mention anyone else.

Every day, staff from Maddie’s Place transported her to a clinic for methadone, administered in pill form. Gradually, she was starting to get clean.

She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own family in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in awe of the small baby 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 dressed in casual attire, a beanie with a pompom on her head, resting on the floor with the door behind her. She is slender. Her face is downcast so you miss her features. She is lifting the baby on her lap for the other kids to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if possible.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I would become a mother.”

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Methods to address drug-exposed newborns have existed for decades.

The Finnegan NAS scale was developed in 1975|