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Pregnant and experiencing intense discomfort, the expectant mother arrived at the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also dependent on fentanyl.

As physicians addressed her infection, she began to panic. Withdrawal was setting in. She slumped forward and threw up.

Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”

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 four weeks left to figure out how to get clean and have this baby.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie delivered a daughter weighing just over four pounds – early, small but alive.

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

She felt ill. Not ready for motherhood. Not fit.

Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she failed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became clearly expecting.

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

The common assumption that her affection for her child would make her stop using only led to increased guilt and self-abuse, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was hooked up to tubes and leads, so tiny she thought she would harm her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name Izzie, after the professional who provided support to her.

Hospital staff told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a developing system of centers like the care home is proving a simple point: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to collect her.

She stepped out of the hospital still in recovery, fearful and unsure about what would happen next.

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At the facility, Stephanie still feared that authorities would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and separate them.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about getting by. Substances came first; faith came last.

Stephanie had a single companion, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She did not know how to value herself, not to mention anyone else.

Each day, staff from the center took her to a recovery program, provided orally. Slowly, she was beginning recovery.

She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies exposed to substances.

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

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. An advocate, a peer support specialist, visited with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. 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 bobble on her head, seated on the ground with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is presenting her daughter on her knee for the children to see and they are gathered around, admiring and touching to the baby.

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

“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 made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could be a mom.”

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Methods to address drug-exposed newborns have existed for decades.

The evaluation method was created in 1975|