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In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the ER after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had constructed in a friend’s yard. She was also dependent on fentanyl.

As doctors treated her infection, she began to panic. Withdrawal was setting in. She slumped forward and vomited.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to plan her recovery and have this baby.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

After five days, on the 12th of November, Stephanie gave birth to a daughter weighing a small weight – premature, small but alive.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her last dose of fentanyl had been administered a few hours prior to birth.

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

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she failed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her dealer refused to sell to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The common assumption that her love for her baby would make her recover only led to increased guilt and self-harm, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to monitors, so small she thought she would hurt her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

After two days she decided to name her baby the same as her nurse, after the professional who provided support to her.

Nurses and doctors told her about a care center, a innovative treatment home where women and their babies are treated together, not apart.

In much of the US, where a baby is identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like the care home is showing an important truth: when mothers and babies stay together, results get better, foster placements fall and overall savings increase.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to collect her.

She stepped out of the hospital still in detox, anxious and doubtful about what would happen next.

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At the care center, Stephanie still worried that child services would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and separate them.

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

Survival outdoors, she said, was about getting by. Drugs came first; reliance came last.

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to cause pain. She did not know how to value herself, let alone anyone else.

Every day, staff from Maddie’s Place took her to a clinic for methadone, administered in pill form. Gradually, she was embracing sobriety.

She devoted all her time when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with adverse reactions to milk and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I could do this. I could parent.

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. A support specialist, a peer support specialist, stopped by with her own five kids in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed 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 has an image of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. She is slender. Her face is downcast so you cannot see her face. She is holding Izzie up on her leg for the children to see and they are gathered around, showing interest to the baby.

One child, eight, asked the moms: “What about the fathers?” The parents responded that the dads were busy, called away to other tasks, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could parent.”

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Tools for treating infants affected by substances have been used for a long time.

The assessment tool was developed in 1975|