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Pregnant and experiencing intense discomfort, a woman named Stephanie visited the medical facility after her infection worsened up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and threw up.

Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had just enough time to get treated before she had to return to use once more. She thought she still had a month remaining to find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection was severe, but physicians found she also had an amniotic fluid leak. 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 controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

After five days, on 12 November 2022, Stephanie delivered a daughter weighing just over four pounds – early, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she failed. She felt worthless, berating herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her source would not provide to her when she became visibly pregnant.

“Yet I was unable,” she said. “I required assistance.”

The widespread belief that her affection for her child would make her quit only led to increased guilt and self-harm, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The baby was taken to the special care nursery. When Stephanie at last met her, she was attached to monitors, so small she thought she would break her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” 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.

Medical personnel told her about a specialized facility, a new kind of care center where women and their babies are treated together, not apart.

In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like the care home is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and overall savings increase.

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 detox, scared and uncertain about what would follow.

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At the care center, Stephanie still was concerned that child services would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could enter and remove her child.

For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about getting by. Drugs came first; trust came last.

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to let her down. She lacked the ability to value herself, much less anyone else.

Each day, staff from the facility took her to a recovery program, given as medication. Over time, she was starting to get clean.

She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support 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 professional – all frequent conditions for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is wearing dark trousers and a sweatshirt, a cap with a decoration on her head, resting on the floor with the entryway at her back. She is slender. Her posture is humble so you do not see her expression. She is lifting the baby on her knee for the other kids to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the mothers: “Where are all the dads?” The parents responded that the men were occupied, handling responsibilities, that they would be there if possible.

“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion exchanged glances. “I broke down,” 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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Approaches for managing infants affected by substances have been available for years.

The Finnegan NAS scale was created in 1975|