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Eight months pregnant and in severe pain, a woman named Stephanie arrived at the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had assembled in a companion's property. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to plan her recovery and give birth.

The nurse had other ideas. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was serious, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

After five days, on 12 November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, little but surviving.

When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.

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

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she relapsed. She felt hopeless, blaming herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her supplier refused to sell to her when she became clearly expecting.

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

The pervasive expectation that her bond with her newborn would make her recover only led to greater shame and self-abuse, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.

The infant was moved to the special care nursery. When Stephanie at last met her, she was connected to monitors, so tiny she thought she would hurt her. Embracing her at last, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.

Hospital staff told her about a care center, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a small, growing network of centers like the care home is demonstrating a key fact: when families are kept intact, recovery succeeds, custody cases decrease and future expenses reduce.

It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, care providers came to bring her to the facility.

She left the medical center still in recovery, scared and uncertain about what would happen next.

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At the care center, Stephanie still worried that child services would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any point, someone could enter and remove her child.

For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about survival. Drugs came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to care for herself, much less anyone else.

Each day, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Over time, she was embracing sobriety.

She devoted all her time beyond therapy 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 heightened sensory issues and required an specialist – all common issues for babies born with NAS.

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

During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. An advocate, a mentor, came over with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She has an image of the moment. She is wearing black pants and a hoodie, a cap with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her posture is humble so you do not see her expression. She is lifting the baby on her leg for the children to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there if they could.

“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I could parent.”

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Tools for treating infants affected by substances have existed for decades.

The assessment tool was created in 1975|