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Pregnant and experiencing intense discomfort, the expectant mother visited the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had assembled in a companion's property. She was also dependent on fentanyl.

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

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

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had four weeks left to plan her recovery and give birth.

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 condition in her limbs was severe, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

Five days later, on 12 November 2022, Stephanie gave birth to a baby girl weighing a small weight – early, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been administered shortly before she gave birth.

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

Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she failed. She felt worthless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became visibly pregnant.

“However, I failed,” she said. “I needed help.”

The common assumption that her bond with her newborn would make her stop using only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to medical equipment, so little she thought she would break her. Holding her for the first time, she felt nothing. “I looked 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 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 women and their babies are treated together, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition frequently, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when mothers and babies stay together, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

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

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At the care center, Stephanie still feared that authorities would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could walk in and remove her child.

For the first two weeks, Stephanie kept to herself. “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; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to cause pain. She was unable to love herself, much less anyone else.

Each day, staff from Maddie’s Place took her to a clinic for methadone, given as medication. Slowly, she was starting to get clean.

She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a recovery coach, visited with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, sitting on the wooden floor with the door behind her. She is lean. Her posture is humble so you do not see her expression. She is lifting the baby on her lap for the children to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could parent.”

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Tools for treating infants affected by substances have been used for a long time.

The Finnegan NAS scale was created in 1975|