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In her eighth month of pregnancy and suffering, the expectant mother went to the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had constructed in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”

She had taken the drug before coming to the ER 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 find a way to become sober and have this baby.

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

“I am leaving,” Stephanie said.

But the doctors would not let her go: the leg infection was severe, 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.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.

A short time later, on 12 November 2022, Stephanie gave birth to a baby girl weighing a small weight – premature, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been given four hours before delivery.

She felt ill. Unprepared to be a mother. Unworthy.

Stephanie had sought recovery repeatedly before birth, and felt horrible each time she was unsuccessful. She felt worthless, berating herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her supplier would not provide to her when she became visibly pregnant.

“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 greater shame and self-abuse, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would hurt her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to name her baby the same as her nurse, after the professional who provided support to her.

Nurses and doctors told her about a specialized facility, a unique recovery environment where women and their babies are treated together, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a developing system of centers like the care home is showing an important truth: when parents and infants remain united, outcomes improve, 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 confirming she would be a good fit for the program, care providers came to bring her to the facility.

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

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At the care center, Stephanie still was concerned that child services would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and separate them.

For the beginning period, 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 survival. Addiction came first; faith came last.

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to cause pain. She lacked the ability to care for herself, not to mention anyone else.

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

She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an professional – all common issues for babies affected by withdrawal.

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

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, stopped by with her own children in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She holds a picture of the moment. She is wearing black pants and a hoodie, a gray knit hat with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her knee for the young ones to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if possible.

“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I would become a mother.”

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Methods to address babies with exposure have existed for decades.

The Finnegan NAS scale was developed in 1975|