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Pregnant and experiencing intense discomfort, the expectant mother visited the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had built in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. 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 needed to go home to relapse. She thought she still had several weeks to find a way to become sober and give birth.

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

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but doctors had discovered she also had an ruptured membrane. 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 regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

Five days later, on the 12th of November, Stephanie had a infant weighing 4lb 8oz – premature, small but alive.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.

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

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer declined to supply to her when she became obviously with child.

“However, I failed,” she said. “I needed help.”

The widespread belief that her affection for her child would make her stop using only led to greater shame and negative self-talk, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the NICU. When Stephanie finally saw her her, she was connected to monitors, so tiny she thought she would break her. Cradling her initially, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to name her baby Izzie, after the attendant who showed compassion to her.

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

In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

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

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

For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about enduring. Addiction came first; trust came last.

Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She lacked the ability to love herself, much less anyone else.

Each day, staff from the center drove her to a treatment center, administered in pill form. Slowly, she was starting to get clean.

She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all typical problems for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

On a day prior to the holiday, 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 deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She has an image of the moment. She is dressed in black pants and a hoodie, a beanie with a bobble on her head, resting on the floor with the entryway at her back. She is slender. Her face is downcast so you miss her features. She is presenting her daughter on her knee for the young ones to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the parents: “Why are there no men?” The parents responded that the dads were busy, handling responsibilities, that they would be there if possible.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could parent.”

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Tools for treating drug-exposed newborns have been used for a long time.

The assessment tool was developed in 1975|