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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after her infection worsened up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she had to return to use once more. She thought she still had a month remaining to find a way to become sober and deliver her child.

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

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, 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. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

A short time later, on the 12th of November, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, small but alive.

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 last dose of fentanyl had been administered a few hours prior to birth.

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

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her dealer declined to supply to her when she became clearly expecting.

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

The widespread belief that her affection for her child would make her recover only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the special care nursery. When Stephanie eventually visited her, she was hooked up to medical equipment, so little she thought she would break her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, after the professional who provided support to her.

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

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and medicated while their mothers face parental assessments. But a small, growing network of centers like this facility is proving a simple point: when parents and infants remain united, recovery succeeds, fewer children enter care and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

She left the medical center still in recovery, anxious and doubtful about what would happen next.

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At the care center, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any time, someone could walk in and separate them.

For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about getting by. Addiction came first; faith came last.

Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She was unable to love herself, much less anyone else.

Each day, staff from the facility transported her to a recovery program, administered in pill form. Over time, she was embracing sobriety.

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 intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all common issues for babies born with NAS.

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

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a peer support specialist, visited with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She has an image of the moment. She is dressed in casual attire, a beanie with a bobble on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her lap for the children to see and they are gathered around, admiring and touching to the baby.

One child, eight, asked the mothers: “What about the fathers?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could parent.”

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Approaches for managing babies with exposure have been used for a long time.

The Finnegan NAS scale was developed in 1975|