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In her eighth month of pregnancy and suffering, a woman named Stephanie went to the ER after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had consumed opioids before seeking medical help and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to find a way to become sober and deliver her child.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.

After five days, on a day in November 2022, Stephanie had a baby girl weighing just over four pounds – born before term, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been administered shortly before she gave birth.

She felt ill. Unprepared to be a mother. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she failed. She felt without value, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her dealer refused to sell to her when she became obviously with child.

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

The widespread belief that her bond with her newborn would make her quit only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.

The infant was moved to the NICU. When Stephanie eventually visited her, she was attached to medical equipment, so small she thought she would break her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to call her daughter after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about a care center, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like this facility is showing an important truth: when mothers and babies stay together, recovery succeeds, foster placements fall and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.

She left the medical center still in withdrawal, anxious and doubtful about what would come next.

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At the care center, Stephanie still was concerned that CPS would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could arrive and take her baby away.

For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about enduring. Drugs came first; trust came last.

Stephanie had one close friend, 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, let alone anyone else.

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

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 intolerance to some formulas and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an specialist – all typical problems for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. A support specialist, a peer support specialist, stopped by with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo 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 entryway at her back. She is lean. Her head is tilted forward so you cannot see her face. She is lifting the baby on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and the specialist exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could parent.”

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Tools for treating drug-exposed newborns have been available for years.

The assessment tool was developed in 1975|