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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had built in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She slumped forward and threw up.

Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”

She had taken the drug before arriving at the hospital and had only a brief window to get treated before she had to return to get high again. She thought she still had four weeks left to plan her recovery and give birth.

The medical professional intervened. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie gave birth to a daughter weighing just over four pounds – early, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been given four hours before delivery.

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

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she failed. She felt worthless, blaming herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her dealer would not provide to her when she became visibly pregnant.

“Yet I was unable,” she said. “I needed help.”

The widespread belief that her love for her baby would make her quit only led to increased guilt and negative self-talk, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.

The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to monitors, so tiny she thought she would hurt her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Two days later she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like this facility is demonstrating a key fact: 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 pick her up.

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

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At the care center, Stephanie still worried that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could walk in and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” 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 connection was tenuous. The individuals she cared for always found ways to cause pain. She did not know how to value herself, not to mention anyone else.

Daily, staff from Maddie’s Place took her to a clinic for methadone, administered in pill form. Slowly, she was starting to get clean.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an specialist – all frequent conditions 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.

During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, stopped by with her own children in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is presenting her daughter on her knee for the children to see and they are crowding near, admiring and touching to the baby.

A young boy, eight, asked the parents: “What about the fathers?” The parents responded that the men were occupied, called away to other tasks, that they would be there if possible.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

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 would become a mother.”

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Methods to address drug-exposed newborns have been available for years.

The Finnegan NAS scale was established in 1975|