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In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the ER after her infection worsened up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She slumped forward and became sick.

Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”

She had used fentanyl 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 find a way to become sober and give birth.

The medical professional intervened. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

A short time later, on the 12th of November, Stephanie gave birth to a baby girl weighing 4lb 8oz – early, tiny yet healthy.

When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been given a few hours prior to birth.

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

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she relapsed. She felt without value, berating herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her supplier refused to sell to her when she became clearly expecting.

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

The common assumption that her love for her baby would make her stop using only led to increased guilt and self-abuse, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would harm her. Holding her for the first time, she felt detached. “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 name her baby the same as her nurse, after the nurse who had been so kind to her.

Medical personnel told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, outcomes improve, foster placements fall and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to pick her up.

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

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At the care center, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any point, someone could enter and remove her child.

For the first two weeks, Stephanie kept to herself. “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 getting by. Drugs came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to let her down. She did not know how 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 spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. 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 was capable. I could parent.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. An advocate, a peer support specialist, visited with her own children 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 tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She holds a picture of the moment. She is clad in casual attire, a gray knit hat with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her face is downcast so you miss her features. She is holding Izzie up on her lap for the young ones to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if possible.

“Once I become a parent,” Jacob said, “I plan to be a great parent. 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. “If this little kid could see that infants need affection, then I could do this. I would become a mother.”

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Tools for treating infants affected by substances have existed for decades.

The Finnegan NAS scale was developed in 1975|