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Eight months pregnant and in severe pain, a woman named Stephanie arrived at 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 doctors treated her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”

She had used fentanyl before coming to the ER and had just enough time to get treated before she was compelled to leave to relapse. She thought she still had a month remaining to figure out how to get clean and give birth.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection was critical, 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 be at risk of death.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.

After five days, on a day in November 2022, Stephanie delivered a daughter weighing 4lb 8oz – early, tiny yet healthy.

When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her final administration of fentanyl had been provided four hours before delivery.

She felt ill. Ill-equipped for parenting. Unworthy.

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she relapsed. She felt worthless, blaming herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her dealer declined to supply to her when she became obviously with child.

“However, I failed,” she said. “I had to seek support.”

The widespread belief that her bond with her newborn would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.

The newborn was transferred to the NICU. When Stephanie at last met her, she was attached to monitors, so small she thought she would harm her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to call her daughter after her caregiver, after the professional who provided support to her.

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

In numerous states, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like this facility is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to pick her up.

She departed the institution still in recovery, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still was concerned that authorities would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could arrive and separate them.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about enduring. Drugs came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to let her down. She was unable to value herself, much less anyone else.

Each day, staff from Maddie’s Place transported her to a recovery program, given as medication. Slowly, she was beginning recovery.

She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all frequent conditions for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I could be a mom.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a mentor, stopped by with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

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

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a pompom on her head, sitting on the wooden floor with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her lap for the young ones to see and they are crowding near, admiring and touching to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I would become a mother.”

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Methods to address babies with exposure have been used for a long time.

The Finnegan NAS scale was created in 1975|