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Pregnant and experiencing intense discomfort, the expectant mother arrived at the ER after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had constructed in a friend’s yard. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and vomited.

Stephanie ultimately gave in. “I need to leave. 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 was compelled to leave to relapse. She thought she still had four weeks left to find a way to become sober and have this baby.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

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

The nurse convinced 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 switched to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

A short time later, on a day in November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – premature, little but surviving.

When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her pain relief did not work, her final administration of fentanyl had been administered four hours before delivery.

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

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she relapsed. She felt worthless, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer refused to sell to her when she became clearly expecting.

“Yet I was unable,” she said. “I needed help.”

The pervasive expectation that her affection for her child would make her recover only led to increased guilt and negative self-talk, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to medical equipment, so tiny she thought she would break her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

After two days she decided to call her daughter after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are treated together, not apart.

In numerous states, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a small, growing network of centers like the care home is showing an important truth: when parents and infants remain united, results get better, custody cases decrease and overall savings increase.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to bring her to the facility.

She departed the institution still in recovery, fearful and unsure about what would follow.

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At the facility, Stephanie still worried that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could enter and separate them.

For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about getting by. Drugs came first; faith 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 lacked the ability to love herself, not to mention anyone else.

Every day, staff from the facility took her to a recovery program, given as medication. Gradually, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all typical problems for babies affected by withdrawal.

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

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, visited with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She keeps a photo of the moment. She is wearing black pants and a hoodie, a cap with a pompom on her head, sitting on the wooden floor with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her knee for the young ones to see and they are gathered around, showing interest to the baby.

One child, eight, asked the moms: “What about the fathers?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there if possible.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I would become a mother.”

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Methods to address drug-exposed newborns have been available for years.

The evaluation method was developed in 1975|