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In her eighth month of pregnancy and suffering, a woman named Stephanie went to the ER after her infection worsened up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie eventually collapsed. “I need to leave. 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 use once more. She thought she still had several weeks to plan her recovery and have this baby.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, 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. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

Five days later, on 12 November 2022, Stephanie gave birth to a daughter weighing a small weight – born before term, small but alive.

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

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

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she relapsed. She felt worthless, berating herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her dealer declined to supply to her when she became visibly pregnant.

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

The pervasive expectation that her affection for her child would make her quit only led to greater shame and self-abuse, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.

The infant was moved to the NICU. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would break her. Embracing her at last, she felt empty. “I looked at 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 give her child the name after her caregiver, after the attendant who showed compassion to her.

Medical personnel told her about a care center, a new kind of care center where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, foster placements fall and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to collect her.

She left the medical center still in detox, fearful and unsure about what would come next.

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At the facility, Stephanie still was concerned that child services would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could arrive and remove her child.

For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about getting by. Addiction came first; trust came last.

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to cause pain. She was unable to value herself, much less anyone else.

Every day, staff from the center transported her to a clinic for methadone, given as medication. Over time, she was starting to get clean.

She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an specialist – all frequent conditions for babies exposed to substances.

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

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a cap with a pompom on her head, resting on the floor with the door behind her. She is thin. Her face is downcast so you miss her features. She is presenting her daughter on her knee for the children to see and they are standing close, fawning and reaching out to the baby.

A young boy, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could parent.”

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Methods to address infants affected by substances have been used for a long time.

The assessment tool was developed in 1975|