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In her eighth month of pregnancy and suffering, the expectant mother went to the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had assembled in a acquaintance's garden. She was also dependent on fentanyl.

As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to plan her recovery and have this baby.

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

“I am leaving,” Stephanie said.

But the doctors would not let her go: the leg infection was critical, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten 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 addiction recovery.

After five days, on a day in November 2022, Stephanie had a daughter weighing a small weight – born before term, tiny yet healthy.

When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given shortly before she gave birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier refused to sell to her when she became clearly expecting.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her love for her baby would make her quit only led to greater shame and self-abuse, a trigger 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 newborn was transferred to the NICU. When Stephanie eventually visited her, she was hooked up to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.

Hospital staff told her about a care center, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition frequently, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, outcomes improve, custody cases decrease and future expenses reduce.

It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, two staff members came to collect her.

She left the medical center still in withdrawal, scared and uncertain about what would happen next.

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At Maddie’s Place, Stephanie still was concerned that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could enter and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”

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

Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to cause pain. She was unable to love herself, not to mention anyone else.

Each day, staff from the facility drove her to a clinic for methadone, administered in pill form. Gradually, she was beginning recovery.

She spent every minute 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 severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies born with NAS.

Seeing that even a young person understands the need for care, then I found the strength. I could parent.

On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” 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 clad in black pants and a hoodie, a cap with a decoration on her head, resting on the floor with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is lifting the baby on her leg for the young ones to see and they are standing close, showing interest to the baby.

One child, eight, asked the moms: “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.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.”

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Methods to address drug-exposed newborns have been available for years.

The assessment tool was established in 1975|