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Eight months pregnant and in severe pain, a woman named Stephanie went to the ER after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had built in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to plan her recovery and have this baby.

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

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie had a infant weighing just over four pounds – early, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been administered shortly before she gave birth.

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

Stephanie had tried to get clean several times during pregnancy, and felt awful each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her source declined to supply to her when she became visibly pregnant.

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

The widespread belief that her affection for her child would make her recover only led to deeper self-loathing and self-harm, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was attached to medical equipment, so little she thought she would hurt her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to name her baby Izzie, after the nurse who had been so kind to her.

Medical personnel told her about a care center, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like the care home is demonstrating a key fact: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to pick her up.

She departed the institution still in detox, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still was concerned that child services would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could arrive and separate them.

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

Life on the streets, she said, was about survival. Addiction came first; trust came last.

Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to hurt her. She lacked the ability to love herself, much less anyone else.

Daily, staff from Maddie’s Place transported her to a clinic for methadone, given as medication. Gradually, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an specialist – all frequent conditions for babies exposed to substances.

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

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for supervised visits with their babies. A support specialist, a peer support specialist, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The young ones stared in wonder 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 holds a picture of the moment. She is dressed in casual attire, a gray knit hat with a decoration on her head, seated on the ground with the entryway at her back. She is thin. Her posture is humble so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there if they could.

“In the future,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I could parent.”

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Tools for treating infants affected by substances have existed for decades.

The Finnegan NAS scale was created in 1975|