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Pregnant and experiencing intense discomfort, a woman named Stephanie went to the ER after her infection worsened up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had built in a acquaintance's garden. She was also dependent on fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and became sick.

Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”

She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to find a way to become sober and deliver her child.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – early, small but alive.

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

She felt unwell. Ill-equipped for parenting. Not fit.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she relapsed. She felt worthless, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became clearly expecting.

“Yet I was unable,” she said. “I had to seek support.”

The common assumption that her love for her baby would make her quit only led to greater shame and self-harm, a trigger for her to relapse. Yet she could not simply will 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 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 gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to give her child the name the same as her nurse, after the professional who provided support to her.

Nurses and doctors told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.

In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: 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 ultimately reached out. After ensuring she qualified for the program, two staff members came to bring her to the facility.

She stepped out of the hospital still in recovery, anxious and doubtful about what would follow.

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At the facility, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and separate them.

For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”

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

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She was unable to love herself, let alone anyone else.

Daily, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Over time, she was starting to get clean.

She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues for babies exposed to substances.

When a child recognizes these infants need affection, then I could do this. I could parent.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, visited with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the tiny infant 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 beanie with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her posture is humble so you do not see her expression. She is lifting the baby on her lap for the young ones to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“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 Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could be a mom.”

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Methods to address babies with exposure have been used for a long time.

The evaluation method was created in 1975|