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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward 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 needed to go home to relapse. She thought she still had a month remaining to figure out how to get clean and deliver her child.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but medical staff detected she also had an leakage of amniotic fluid. 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 periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.

After five days, on the 12th of November, Stephanie delivered a baby girl weighing just over four pounds – early, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been provided a few hours prior to birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she failed. She felt worthless, berating herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her dealer declined to supply to her when she became clearly expecting.

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

The common assumption that her affection for her child would make her stop using only led to greater shame and self-harm, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was attached to monitors, so small she thought she would hurt her. Embracing her at last, she felt nothing. “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 call her daughter after her caregiver, after the nurse who had been so kind to her.

Nurses and doctors told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a developing system of centers like this facility is showing an important truth: when mothers and babies stay together, results get better, fewer children enter care and future expenses reduce.

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, care providers came to pick her up.

She left the medical center still in recovery, anxious and doubtful about what would happen next.

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At the facility, Stephanie still was concerned that authorities would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could walk in and take her baby away.

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

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

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She was unable to value herself, much less anyone else.

Every day, staff from Maddie’s Place drove her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.

She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an professional – all typical problems for babies born with NAS.

When a child recognizes these infants need affection, then I was capable. I could be a mom.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. A support specialist, a mentor, visited with her own five kids in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is dressed in casual attire, a beanie with a decoration on her head, resting on the floor with the door behind her. She is slender. 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 standing close, fawning and reaching out to the baby.

One child, eight, asked the mothers: “Where are all the dads?” The parents responded that the dads were busy, called away to other tasks, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could parent.”

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Tools for treating babies with exposure have existed for decades.

The Finnegan NAS scale was created in 1975|