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In her eighth month of pregnancy and suffering, the expectant mother arrived at the medical facility after her infection worsened up her legs. Without a job or home, estranged from her family, she resided in a small structure she had built in a friend’s yard. She was also hooked on fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and threw up.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”

She had consumed opioids before coming to the ER and had only a brief window to get treated before she had to return to get high again. She thought she still had a month remaining to find a way to become sober and deliver her child.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she departed, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in addiction recovery.

Five days later, on a day in November 2022, Stephanie delivered a daughter weighing 4lb 8oz – early, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been provided a few hours prior to birth.

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

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she failed. She felt hopeless, berating herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her supplier would not provide to her when she became clearly expecting.

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

The common assumption that her love for her baby would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.

The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to monitors, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to name her baby the same as her nurse, after the professional who provided support to her.

Nurses and doctors told her about a specialized facility, a unique recovery environment where women and their babies are supported as a unit, not apart.

In numerous states, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is showing an important truth: 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 confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

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

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At the facility, Stephanie still feared that CPS would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could walk in and take her baby away.

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

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

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She lacked the ability to love herself, not to mention anyone else.

Each day, staff from the facility drove her to a treatment center, provided orally. Gradually, 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 sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had sensory challenges and required an professional – all typical problems for babies born with NAS.

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

One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a mentor, stopped by 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 kids looked amazed in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She has an image of the moment. She is wearing black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the exit nearby. She is lean. Her face is downcast so you cannot see her face. She is presenting her daughter on her knee for the children to see and they are standing close, 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, called away to other tasks, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”

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

The Finnegan NAS scale was created in 1975|