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Pregnant and experiencing intense discomfort, the expectant mother went to the ER after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and vomited.

Stephanie eventually collapsed. “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 use once more. She thought she still had four weeks left to figure out how to get clean and deliver her child.

The medical professional intervened. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the leg infection was serious, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

After five days, on 12 November 2022, Stephanie gave birth to a daughter weighing just over four pounds – premature, little but surviving.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her epidural had failed, 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 multiple times while expecting, and felt horrible each time she was unsuccessful. She felt without value, blaming herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became visibly pregnant.

“However, I failed,” she said. “I needed help.”

The common assumption that her bond with her newborn would make her quit only led to greater shame and self-harm, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.

The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was connected to monitors, so little she thought she would hurt her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

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

Medical personnel told her about a care center, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a developing system of centers like this facility is proving a simple point: when mothers and babies stay together, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to pick her up.

She stepped out of the hospital still in recovery, anxious and doubtful about what would follow.

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At the care center, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could arrive and remove her child.

For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about getting by. Drugs came first; reliance came last.

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

Every day, staff from the facility drove her to a clinic for methadone, provided orally. Over time, she was starting to get clean.

She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an specialist – all typical problems for babies exposed to substances.

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

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. An advocate, a mentor, visited with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the tiny infant 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 wearing dark trousers and a sweatshirt, a beanie with a bobble on her head, sitting on the wooden floor with the door behind her. She is lean. Her posture is humble so you miss her features. She is holding Izzie up on her lap for the other kids to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the moms: “Why are there no men?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could be a mom.”

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Methods to address infants affected by substances have existed for decades.

The Finnegan NAS scale was developed in 1975|