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In her eighth month of pregnancy and suffering, the expectant mother visited the medical facility after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also hooked on fentanyl.

As medical staff managed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and became sick.

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before coming to the ER and had only a brief window to get treated before she needed to go home to get high again. She thought she still had several weeks to figure out how to get clean and have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.

Five days later, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – early, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been provided four hours before delivery.

She felt unwell. Ill-equipped for parenting. Unworthy.

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she failed. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her dealer declined to supply to her when she became obviously with child.

“However, I failed,” she said. “I required assistance.”

The widespread belief that her love for her baby would make her stop using 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 overcome a persistent condition.

The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to tubes and leads, so little she thought she would harm her. Embracing her at last, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to name her baby after her caregiver, after the attendant who showed compassion to her.

Nurses and doctors told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like this facility is showing an important truth: when parents and infants remain united, results get better, foster placements fall and long-term costs decline.

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

She stepped out of the hospital still in withdrawal, scared and uncertain about what would follow.

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At the care center, Stephanie still was concerned that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could arrive and remove her child.

For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about enduring. Addiction came first; faith came last.

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to let her down. She lacked the ability to love herself, not to mention anyone else.

Every day, staff from the center took her to a treatment center, administered in pill form. Slowly, she was beginning recovery.

She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an professional – all frequent conditions for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I could parent.

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. An advocate, a mentor, visited with her own five kids in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed 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. None of those things mattered to them.”

She has an image of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a pompom on her head, sitting on the wooden floor with the exit nearby. She is slender. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the other kids to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the parents: “Why are there no men?” 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 Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I would become a mother.”

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Tools for treating babies with exposure have existed for decades.

The assessment tool was established in 1975|