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In her eighth month of pregnancy and suffering, a woman named Stephanie went to the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had built in a friend’s yard. She was also dependent on fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She slumped forward and vomited.

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

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had a month remaining to figure out how to get clean and have this baby.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was critical, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.

A short time later, on the 12th of November, Stephanie had a baby girl weighing just over four pounds – premature, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her previous intake of fentanyl had been administered four hours before delivery.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.

“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 self-harm, a trigger for her to relapse. 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 attached to monitors, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Following a brief period 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 women and their babies are treated together, not apart.

In much of the US, where a baby is identified with newborn addiction symptoms regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like the care home is proving a simple point: when parents and infants remain united, recovery succeeds, custody cases decrease and long-term costs decline.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to pick her up.

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

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

For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about survival. Addiction came first; trust came last.

Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to hurt her. She was unable to value herself, not to mention anyone else.

Each day, staff from the center drove her to a recovery program, provided orally. Over time, she was embracing sobriety.

She utilized each moment 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 adverse reactions to milk and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all typical problems for babies born with NAS.

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

During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, came over with her own children in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in wonder 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 casual attire, a beanie with a bobble on her head, seated on the ground with the exit nearby. She is slender. Her face is downcast so you do not see her expression. She is holding Izzie up on her lap for the other kids to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if possible.

“When I have kids,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could be a mom.”

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Tools for treating drug-exposed newborns have been used for a long time.

The assessment tool was created in 1975|