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Pregnant and experiencing intense discomfort, the expectant mother went to the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled 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 threw up.

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

She had used fentanyl 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 attending nurse disagreed. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was severe, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – early, small but alive.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been given shortly before she gave birth.

She felt ill. Unprepared to be a mother. Undeserving.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her source refused to sell to her when she became clearly expecting.

“But I couldn’t,” 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 self-harm, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was attached to tubes and leads, so small she thought she would break her. Embracing her at last, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

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

Medical personnel told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are supported as a unit, not apart.

In numerous states, where a baby is found to have newborn addiction symptoms frequently, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a small, growing network of centers like this facility is proving a simple point: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to collect her.

She left the medical center still in detox, fearful and unsure about what would happen next.

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At Maddie’s Place, Stephanie still feared that child services would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any point, someone could enter and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”

Homelessness, she said, was about enduring. Substances came first; reliance came last.

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to let her down. She was unable to care for herself, not to mention anyone else.

Every day, staff from the facility took her to a treatment center, administered in pill form. Gradually, she was embracing sobriety.

She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an specialist – all common issues for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I could be a mom.

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. An advocate, a mentor, stopped by with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is clad in casual attire, a beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is lean. 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, admiring and touching to the baby.

A young boy, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if they could.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could parent.”

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Tools for treating babies with exposure have been used for a long time.

The Finnegan NAS scale was established in 1975|