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Eight months pregnant and in severe pain, a woman named Stephanie visited the medical facility after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and vomited.

Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”

She had taken the drug before arriving at the hospital and had only a brief window to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and give birth.

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 critical, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.

A short time later, on the 12th of November, Stephanie had a baby girl weighing a small weight – born before term, small but alive.

When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been given shortly before she gave birth.

She felt unwell. Not ready for motherhood. Not fit.

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she relapsed. She felt without value, blaming herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her source refused to sell to her when she became visibly pregnant.

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

The common assumption that her bond with her newborn would make her quit only led to greater shame and self-harm, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The baby was taken to the NICU. When Stephanie eventually visited her, she was connected to tubes and leads, so tiny she thought she would harm her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to give her child the name after her caregiver, after the professional who provided support to her.

Medical personnel told her about a specialized facility, a new kind of care center where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when families are kept intact, recovery succeeds, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to pick her up.

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

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At Maddie’s Place, Stephanie still worried that CPS would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any point, someone could arrive and separate them.

For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about survival. Drugs came first; trust came last.

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to hurt her. She lacked the ability to value herself, much less anyone else.

Each day, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Over time, she was starting to get clean.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an professional – all typical problems for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” 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, sitting on the wooden floor with the exit nearby. She is lean. Her posture is humble so you do not see her expression. She is holding Izzie up on her lap for the young ones to see and they are crowding near, showing interest to the baby.

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

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could be a mom.”

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Approaches for managing babies with exposure have been used for a long time.

The Finnegan NAS scale was created in 1975|