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Eight months pregnant and in severe pain, the expectant mother visited the medical facility after her infection worsened up her legs. Jobless and without shelter, 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 physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had taken the drug before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to figure out how to get clean and deliver her child.

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

“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 ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

Five days later, on the 12th of November, Stephanie gave birth to a infant weighing 4lb 8oz – early, tiny yet healthy.

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

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she relapsed. She felt without value, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her source declined to supply to her when she became visibly pregnant.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her love for her baby would make her recover only led to increased guilt and negative self-talk, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The baby was taken to the NICU. When Stephanie finally saw her her, she was connected to tubes and leads, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

After two days she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.

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

In numerous states, where a baby is found to have infant withdrawal condition frequently, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is proving a simple point: when parents and infants remain united, outcomes improve, custody cases decrease and overall savings increase.

It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to pick her up.

She departed the institution still in recovery, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could walk in and take her baby away.

For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about getting by. Substances came first; trust came last.

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She lacked the ability to love herself, not to mention anyone else.

Daily, staff from the facility drove her to a recovery program, provided orally. Gradually, she was beginning recovery.

She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an occupational therapist – all common issues for babies exposed to substances.

Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.

During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. An advocate, a mentor, visited with her own children in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed 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 has an image of the moment. She is wearing casual attire, a gray knit hat with a decoration on her head, sitting on the wooden floor with the door behind her. She is slender. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the children to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “Why are there no men?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there if they could.

“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I would become a mother.”

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Approaches for managing drug-exposed newborns have existed for decades.

The evaluation method was established in 1975|