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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and became sick.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had just enough time 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 attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.

Five days later, on the 12th of November, Stephanie delivered a baby girl weighing a small weight – premature, tiny yet healthy.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered a few hours prior to birth.

She felt ill. Unprepared to be a mother. Undeserving.

Stephanie had tried to get clean several times during pregnancy, and felt awful each time she was unsuccessful. She felt worthless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her dealer declined to supply to her when she became obviously with child.

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

The pervasive expectation that her affection for her child would make her recover only led to deeper self-loathing and self-harm, a trigger 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 NICU. When Stephanie eventually visited her, she was connected to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Two days later 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 specialized facility, a innovative treatment home where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to pick her up.

She departed the institution still in recovery, fearful and unsure about what would follow.

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At the care center, Stephanie still was concerned 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 beginning period, Stephanie stayed withdrawn. “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 enduring. Drugs came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She was unable to value herself, let alone anyone else.

Each day, staff from the center took her to a clinic for methadone, given as medication. Slowly, she was starting to get clean.

She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies born with NAS.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own family in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is clad in casual attire, a beanie with a bobble on her head, resting on the floor with the door behind her. She is slender. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are standing close, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if they could.

“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could be a mom.”

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Approaches for managing infants affected by substances have been available for years.

The assessment tool was established in 1975|