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In her eighth month of pregnancy and suffering, the expectant mother went to the medical facility after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had constructed 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 bent over the bedside and became sick.

Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to plan her recovery and give birth.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – early, tiny yet healthy.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been administered a few hours prior to birth.

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

Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her supplier refused to sell to her when she became visibly pregnant.

“Yet I was unable,” she said. “I required assistance.”

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 just wish her addiction away, any more than she could overcome a persistent condition.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to monitors, so little she thought she would break her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.

Nurses and doctors told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is found to have infant withdrawal condition regularly, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when mothers and babies stay together, results get better, custody cases decrease and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to bring her to the facility.

She departed the institution still in detox, anxious and doubtful about what would happen next.

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At the facility, Stephanie still was concerned that child services would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and take her baby away.

For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about enduring. Drugs came first; reliance came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She lacked the ability to value herself, let alone anyone else.

Daily, staff from Maddie’s Place drove her to a treatment center, given as medication. Over time, she was beginning recovery.

She spent every minute beyond therapy 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 pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an specialist – all frequent conditions for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat 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 miss her features. She is lifting the baby on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.

Jacob, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there if they could.

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

Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I would become a mother.”

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Methods to address drug-exposed newborns have been used for a long time.

The Finnegan NAS scale was established in 1975|