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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and became sick.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before seeking medical help and had only a brief window to get treated before she had to return to use once more. She thought she still had four weeks left to find a way to become sober and give birth.

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

“I am leaving,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was critical, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

A short time later, on the 12th of November, Stephanie had a infant weighing just over four pounds – premature, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been provided shortly before she gave birth.

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

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she relapsed. She felt hopeless, berating herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I required assistance.”

The pervasive expectation that her love for her baby would make her stop using only led to greater shame and negative self-talk, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to call her daughter the same as her nurse, after the professional who provided support to her.

Hospital staff told her about a care center, a new kind of care center where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like this facility is proving a simple point: when families are kept intact, recovery succeeds, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, care providers came to collect her.

She departed the institution still in withdrawal, anxious and doubtful about what would come next.

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At the facility, Stephanie still was concerned that child services would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and take her baby away.

For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”

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

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She lacked the ability to care for herself, much less anyone else.

Every day, staff from the center transported her to a clinic for methadone, provided orally. Over time, she was beginning recovery.

She devoted all her time outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I could be a mom.

On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, visited with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her head is tilted forward so you miss her features. She is holding Izzie up on her lap for the other kids to see and they are standing close, admiring and touching to the baby.

Jacob, eight, asked the parents: “Why are there no men?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could parent.”

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Approaches for managing babies with exposure have existed for decades.

The assessment tool was created in 1975|