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In her eighth month of pregnancy and suffering, the expectant mother arrived at the ER after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had constructed in a acquaintance's garden. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before seeking medical help and had only a brief window to get treated before she was compelled to leave to relapse. 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 allowed to leave.

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection was critical, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.

Izzie persuaded 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 switched to methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.

A short time later, on the 12th of November, Stephanie had a daughter weighing a small weight – early, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been administered shortly before she gave birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her supplier refused to sell to her when she became clearly expecting.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the NICU. When Stephanie eventually visited her, she was connected to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

After two days she decided to give her child the name the same as her nurse, after the nurse who had been so kind to her.

Medical personnel told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.

In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a developing system of centers like the care home is proving a simple point: when families are kept intact, recovery succeeds, 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 verifying her eligibility for the program, two staff members came to collect her.

She left the medical center still in withdrawal, anxious and doubtful about what would follow.

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At Maddie’s Place, Stephanie still feared that authorities would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could enter and remove her child.

For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”

Homelessness, she said, was about survival. Drugs came first; reliance came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to let her down. She was unable to love herself, not to mention anyone else.

Every day, staff from Maddie’s Place drove her to a treatment center, provided orally. Slowly, she was starting to get clean.

She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an specialist – all frequent conditions for babies born with NAS.

When a child recognizes these infants need affection, then I found the strength. I could parent.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own children in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She keeps a photo of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the mothers: “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 the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could parent.”

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Tools for treating drug-exposed newborns have existed for decades.

The assessment tool was created in 1975|