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In her eighth month of pregnancy and suffering, the expectant mother visited the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had constructed in a companion's property. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and became sick.

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

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to plan her recovery and have this baby.

The attending nurse disagreed. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

After five days, on a day in November 2022, Stephanie gave birth to a daughter weighing just over four pounds – born before term, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been administered shortly before she gave birth.

She felt ill. Unprepared to be a mother. Undeserving.

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, blaming herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her supplier would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I required assistance.”

The common assumption that her bond with her newborn would make her quit only led to deeper self-loathing and self-abuse, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would break her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

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

Hospital staff told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.

In numerous states, where a baby is identified with infant withdrawal condition regularly, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when parents and infants remain united, recovery succeeds, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, two staff members came to pick her up.

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

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At the facility, Stephanie still was concerned that child services would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could walk in and separate them.

For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about enduring. Substances came first; reliance 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 was unable to value herself, let alone anyone else.

Each day, staff from the facility took her to a clinic for methadone, administered in pill form. Over time, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an specialist – all typical problems for babies exposed to substances.

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

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. An advocate, a peer support specialist, stopped by with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in casual attire, a gray knit hat with a decoration on her head, sitting on the wooden floor with the door behind her. She is thin. Her posture is humble so you do not see her expression. She is presenting her daughter on her lap for the young ones to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if possible.

“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 became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I would become a mother.”

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Approaches for managing drug-exposed newborns have existed for decades.

The assessment tool was developed in 1975|