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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the ER after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and threw up.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had a month remaining to find a way to become sober and have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

A short time later, on the 12th of November, Stephanie gave birth to a baby girl weighing 4lb 8oz – born before term, tiny yet healthy.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been provided four hours before delivery.

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

Stephanie had sought recovery repeatedly before birth, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her source declined to supply to her when she became clearly expecting.

“However, I failed,” she said. “I required assistance.”

The widespread belief that her love for her baby would make her recover only led to greater shame and self-abuse, a impetus for her to return to drugs. 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 special care nursery. When Stephanie finally saw her her, she was connected to monitors, so small she thought she would hurt her. Embracing her at last, she felt nothing. “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.

After two days she decided to call her daughter after her caregiver, after the professional who provided support to her.

Hospital staff told her about a care center, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like this facility is proving a simple point: when families are kept intact, results get better, custody cases decrease and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to collect her.

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

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At the facility, 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 walk in and remove her child.

For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”

Homelessness, she said, was about enduring. Substances came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She lacked the ability to value herself, not to mention anyone else.

Every day, staff from the facility transported her to a treatment center, administered in pill form. Gradually, she was embracing sobriety.

She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all frequent conditions for babies exposed to substances.

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

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. An advocate, a peer support specialist, stopped by with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a pompom on her head, seated on the ground with the exit nearby. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her leg for the children to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could parent.”

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Approaches for managing babies with exposure have been available for years.

The assessment tool was created in 1975|