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Pregnant and experiencing intense discomfort, the expectant mother went to the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had built in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and became sick.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had four weeks left to find a way to become sober and deliver her child.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was severe, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

A short time later, on a day in November 2022, Stephanie delivered a baby girl weighing just over four pounds – premature, tiny yet healthy.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her epidural had failed, her previous intake of fentanyl had been provided a few hours prior to birth.

She felt ill. Ill-equipped for parenting. Undeserving.

Stephanie had sought recovery repeatedly before birth, and felt awful each time she relapsed. She felt without value, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her supplier refused to sell to her when she became obviously with child.

“Yet I was unable,” she said. “I required assistance.”

The pervasive expectation that her affection for her child would make her stop using only led to deeper self-loathing and self-abuse, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to tubes and leads, so tiny she thought she would hurt her. Cradling her initially, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, after the professional who provided support to her.

Medical personnel told her about a care center, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is identified with newborn addiction symptoms regularly, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a limited but expanding group of centers like the care home is showing an important truth: when parents and infants remain united, results get better, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, care providers came to bring her to the facility.

She departed the institution still in detox, anxious and doubtful about what would happen next.

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At the care center, Stephanie still worried that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any time, someone could arrive and take her baby away.

For the first two weeks, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about survival. Substances came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She lacked the ability to love herself, much less anyone else.

Each day, staff from the center transported her to a treatment center, provided orally. Over time, she was starting to get clean.

She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I could be a mom.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a peer support specialist, visited with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She has an image of the moment. She is wearing black pants and a hoodie, a cap with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her face is downcast so you do not see her expression. She is presenting her daughter on her knee for the children to see and they are gathered around, admiring and touching to the baby.

A young boy, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could parent.”

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Approaches for managing babies with exposure have existed for decades.

The Finnegan NAS scale was established in 1975|