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Eight months pregnant and in severe pain, the expectant mother went to the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had assembled in a friend’s yard. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”

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 four weeks left to plan her recovery and give birth.

The attending nurse disagreed. 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 serious, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

A short time later, on a day in November 2022, Stephanie had a baby girl weighing 4lb 8oz – premature, small but alive.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been provided shortly before she gave birth.

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

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she failed. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her source refused to sell to her when she became visibly pregnant.

“But I couldn’t,” she said. “I had to seek support.”

The widespread belief that her affection for her child would make her quit only led to increased guilt and negative self-talk, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.

The baby was taken to the NICU. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would hurt 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.

Following a brief period she decided to give her child the name the same as her nurse, after the nurse who had been so kind 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 cared for jointly, not apart.

In numerous states, where a baby is identified with infant withdrawal condition frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like this facility is demonstrating a key fact: when parents and infants remain united, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to bring her to the facility.

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

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At the care center, Stephanie still worried that child services would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could walk in and separate them.

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

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

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to cause pain. She did not know how to love herself, much less anyone else.

Every day, staff from the center drove her to a treatment center, provided orally. Slowly, she was embracing sobriety.

She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an specialist – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, came over with her own children in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is dressed in casual attire, a beanie with a pompom on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are gathered around, showing interest to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could parent.”

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Methods to address babies with exposure have existed for decades.

The assessment tool was developed in 1975|