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Pregnant and experiencing intense discomfort, a woman named Stephanie visited the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had assembled in a companion's property. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward 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 coming to the ER and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and give birth.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

After five days, on a day in November 2022, Stephanie delivered a infant weighing 4lb 8oz – early, small but alive.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given shortly before she gave birth.

She felt unwell. Unprepared to be a mother. Unworthy.

Stephanie had sought recovery several times during pregnancy, 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 visibly pregnant.

“But I couldn’t,” she said. “I needed help.”

The pervasive expectation that her bond with her newborn would make her quit only led to increased guilt and self-harm, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.

The infant was moved to the special care nursery. When Stephanie finally saw her her, she was connected to medical equipment, so little she thought she would harm her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

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

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

In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, results get better, fewer children enter care and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, two staff members came to pick her up.

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

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At the care center, Stephanie still feared that child services would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could arrive and remove her child.

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

Survival outdoors, she said, was about getting by. Addiction came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to hurt her. She did not know how to value herself, much less anyone else.

Each day, staff from the facility transported her to a clinic for methadone, administered in pill form. Slowly, she was starting to get clean.

She utilized each moment beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. 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 found the strength. I would become a mother.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a peer support specialist, stopped by with her own family in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The young ones stared in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a cap with a pompom on her head, sitting on the wooden floor with the exit nearby. She is lean. Her posture is humble so you cannot see her face. She is presenting her daughter on her leg for the other kids to see and they are crowding near, admiring and touching to the baby.

A young boy, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, called away to other tasks, that they would be there if they could.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could parent.”

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Tools for treating drug-exposed newborns have existed for decades.

The evaluation method was established in 1975|