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In her eighth month of pregnancy and suffering, the expectant mother visited the hospital emergency room after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had built in a companion's property. She was also hooked on fentanyl.

As doctors treated her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl 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 deliver her child.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

After five days, on a day in November 2022, Stephanie delivered a daughter weighing a small weight – premature, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.

She felt ill. Ill-equipped for parenting. Undeserving.

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she relapsed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The widespread belief that her bond with her newborn would make her recover only led to deeper self-loathing and negative self-talk, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to monitors, so little she thought she would harm her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to name her baby after her caregiver, after the attendant who showed compassion to her.

Medical personnel told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with infant withdrawal condition frequently, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, custody cases decrease and future expenses reduce.

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

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

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

For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about enduring. Addiction came first; trust came last.

Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to cause pain. She lacked the ability to care for herself, not to mention anyone else.

Daily, staff from the facility drove her to a treatment center, provided orally. Slowly, she was embracing sobriety.

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 pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an specialist – all common issues for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a mentor, stopped by with her own children in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She holds a picture of the moment. She is wearing casual attire, a cap with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the other kids to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if they could.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could be a mom.”

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Approaches for managing babies with exposure have existed for decades.

The evaluation method was developed in 1975|