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Eight months pregnant and in severe pain, the expectant mother visited the medical facility after an infection began spreading up her legs. Without a job or home, estranged from her family, she lived in a shed she had constructed in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had several weeks to plan her recovery and give birth.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the leg infection was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

After five days, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – premature, tiny yet healthy.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her epidural had failed, her final administration of fentanyl had been provided four hours before delivery.

She felt sick. Ill-equipped for parenting. Not fit.

Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she was unsuccessful. She felt worthless, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her source would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I needed help.”

The common assumption that her bond with her newborn would make her quit only led to greater shame and negative self-talk, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was hooked up to monitors, so tiny she thought she would hurt her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to name her baby after her caregiver, after the attendant who showed compassion to her.

Hospital staff told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like the care home is proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, care providers came to bring her to the facility.

She departed the institution still in withdrawal, scared and uncertain about what would happen next.

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At the care center, Stephanie still was concerned that authorities would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could enter and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about enduring. Addiction came first; faith came last.

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to let her down. She lacked the ability to value herself, much less anyone else.

Each day, staff from Maddie’s Place drove her to a recovery program, administered in pill form. Gradually, she was embracing sobriety.

She spent every minute 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 pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all common issues for babies born with NAS.

When a child recognizes these infants need affection, then I was capable. I could parent.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, visited with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration 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 has an image of the moment. She is clad in casual attire, a beanie with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her face is downcast so you miss her features. 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 mothers: “Why are there no men?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could parent.”

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Approaches for managing drug-exposed newborns have been used for a long time.

The Finnegan NAS scale was created in 1975|