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In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the medical facility after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had built in a friend’s yard. She was also addicted to fentanyl.

As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and became sick.

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to figure out how to get clean and have this baby.

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

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was serious, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, 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 periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

A short time later, on a day in November 2022, Stephanie delivered a baby girl weighing a small weight – premature, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her epidural had failed, her final administration of fentanyl had been given four hours before delivery.

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

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she failed. She felt without value, blaming herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her dealer refused to sell to her when she became obviously with child.

“Yet I was unable,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her recover 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 eventually visited her, she was connected to monitors, so little she thought she would harm her. Embracing her at last, she felt empty. “I just stared 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 give her child the name Izzie, after the nurse who had been so kind to her.

Nurses and doctors told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like the care home is proving a simple point: when families are kept intact, results get better, custody cases decrease and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to collect her.

She departed the institution still in recovery, anxious and doubtful about what would come next.

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At Maddie’s Place, Stephanie still worried that CPS would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could enter and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about getting by. Substances came first; trust came last.

Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She lacked the ability to value herself, much less anyone else.

Each day, staff from the facility took her to a recovery program, given as medication. Gradually, she was beginning recovery.

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 obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an professional – all frequent conditions for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I could do this. 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. A support specialist, a peer support specialist, came over with her own family in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.

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

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a cap with a bobble on her head, sitting on the wooden floor with the exit nearby. She is slender. Her posture is humble so you do not see her expression. She is lifting the baby on her leg for the young ones to see and they are crowding near, fawning and reaching out to the baby.

A young boy, eight, asked the moms: “What about the fathers?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could parent.”

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Approaches for managing babies with exposure have been used for a long time.

The evaluation method was developed in 1975|