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Pregnant and experiencing intense discomfort, a woman named Stephanie went to the hospital emergency room after her infection worsened up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had constructed in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had just enough time to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and give birth.

The attending nurse disagreed. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

A short time later, on the 12th of November, Stephanie had a daughter weighing just over four pounds – premature, tiny yet healthy.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her epidural had failed, her last dose of fentanyl had been provided a few hours prior to birth.

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

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her dealer refused to sell to her when she became obviously with child.

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

The widespread belief that her bond with her newborn would make her stop using only led to increased guilt and self-abuse, 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 baby was taken to the special care nursery. When Stephanie eventually visited her, she was attached to medical equipment, so small she thought she would hurt her. Cradling her initially, 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.

After two days she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.

Medical personnel told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with infant withdrawal condition frequently, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like the care home is showing an important truth: when parents and infants remain united, results get better, fewer children enter care and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

She stepped out of the hospital still in withdrawal, anxious and doubtful about what would come next.

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At the care center, Stephanie still feared that child services would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could walk in and take her baby away.

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

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

Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to let her down. She did not know how to care for herself, much less anyone else.

Every day, staff from the center transported her to a treatment center, provided orally. Gradually, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all typical problems for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.

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 peer support specialist, visited with her own family in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She holds a picture of the moment. She is dressed in black pants and a hoodie, a beanie with a decoration on her head, sitting on the wooden floor with the door behind her. She is slender. Her posture is humble so you cannot see her face. 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.

A young boy, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there given the chance.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could be a mom.”

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Tools for treating drug-exposed newborns have existed for decades.

The assessment tool was created in 1975|