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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the hospital emergency room after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a companion's property. She was also dependent on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and threw up.

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 only a brief window to get treated before she had to return to get high again. She thought she still had several weeks to plan her recovery and deliver her child.

The medical professional intervened. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the leg infection was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

A short time later, on the 12th of November, Stephanie gave birth to a infant weighing 4lb 8oz – born before term, small but alive.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been given shortly before she gave birth.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she relapsed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her source would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I required assistance.”

The widespread belief that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.

The baby was taken to the special care nursery. When Stephanie at last met her, she was connected to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

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

Nurses and doctors told her about a specialized facility, a unique recovery environment where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like the care home is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to pick her up.

She departed the institution still in recovery, anxious and doubtful about what would follow.

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At the care center, Stephanie still worried that authorities would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could enter and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

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

Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She was unable to care for herself, let alone anyone else.

Daily, staff from the center took her to a recovery program, provided orally. Slowly, she was embracing sobriety.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I could be a mom.

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction 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 assembled beside Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She keeps a photo of the moment. She is wearing casual attire, a beanie with a pompom on her head, sitting on the wooden floor with the door behind her. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her lap for the young ones to see and they are crowding near, fawning and reaching out to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if they could.

“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could parent.”

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Approaches for managing babies with exposure have been available for years.

The Finnegan NAS scale was developed in 1975|