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Eight months pregnant and in severe pain, a woman named Stephanie visited the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had built in a companion's property. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and threw up.

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

She had used fentanyl before arriving at the hospital and had just enough time to get treated before she was compelled to leave to relapse. She thought she still had several weeks to find a way to become sober and deliver her child.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

After five days, on the 12th of November, Stephanie had a infant weighing 4lb 8oz – born before term, tiny yet healthy.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.

She felt sick. Unprepared to be a mother. Unworthy.

Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she relapsed. She felt without value, criticizing 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 visibly pregnant.

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

The pervasive expectation that her affection for her child would make her quit only led to increased guilt and self-harm, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the NICU. When Stephanie at last met her, she was hooked up to tubes and leads, so little she thought she would harm her. Holding her for the first time, she felt empty. “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 name her baby the same as her nurse, after the nurse who had been so kind to her.

Hospital staff told her about a care center, a unique recovery environment where women and their babies are treated together, not apart.

In many parts of America, where a baby is identified with newborn addiction symptoms regularly, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a small, growing network of centers like this facility is proving a simple point: when families are kept intact, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength 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 detox, fearful and unsure about what would come next.

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At the care center, Stephanie still feared that CPS would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could arrive and remove her child.

For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about survival. Substances came first; faith came last.

Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to cause pain. She did not know how to care for herself, let alone anyone else.

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

She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an professional – all common issues for babies born with NAS.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. An advocate, a mentor, came over with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The young ones stared in awe of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She holds a picture of the moment. She is clad in black pants and a hoodie, a cap with a pompom on her head, sitting on the wooden floor with the door behind her. She is lean. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her knee for the children to see and they are gathered around, admiring and touching to the baby.

One child, eight, asked the mothers: “What about the fathers?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there if possible.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and the specialist looked at each other. “I became emotional,” 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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Approaches for managing babies with exposure have been available for years.

The Finnegan NAS scale was created in 1975|