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Eight months pregnant and in severe pain, a woman named Stephanie went to the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built 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 bent over the bedside and became sick.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

A short time later, on a day in November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – early, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been given shortly before she gave birth.

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

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her source refused to sell to her when she became clearly expecting.

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

The pervasive expectation that her affection for her child would make her quit only led to deeper self-loathing and negative self-talk, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to tubes and leads, so little she thought she would harm her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

After two days she decided to name her baby after her caregiver, after the nurse who had been so kind to her.

Hospital staff told her about a specialized facility, a innovative treatment home where women and their babies are cared for jointly, not apart.

In numerous states, where a baby is found to have infant withdrawal condition frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to collect her.

She departed the institution still in withdrawal, scared and uncertain about what would happen next.

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At the care center, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could arrive and separate them.

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

Homelessness, 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 let her down. She did not know how to value herself, much less anyone else.

Daily, staff from the center transported her to a treatment center, given as medication. Gradually, she was beginning recovery.

She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all typical problems for babies exposed to substances.

Seeing that even a young person understands the need for care, then I was capable. I could parent.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a recovery coach, visited with her own family in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is clad in casual attire, a gray knit hat with a pompom on her head, sitting on the wooden floor with the door behind her. She is lean. Her posture is humble so you cannot see her face. She is lifting the baby on her lap for the children to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the moms: “Where are all the dads?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I would become a mother.”

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Methods to address babies with exposure have been available for years.

The evaluation method was developed in 1975|