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In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had built in a companion's property. She was also dependent on fentanyl.

As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and became sick.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had several weeks to find a way to become sober and give birth.

The nurse had other ideas. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the leg infection was serious, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

A short time later, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – born before term, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her epidural had failed, her final administration of fentanyl had been administered shortly before she gave birth.

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

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she failed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An doctor 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 had to seek support.”

The pervasive expectation that her love for her baby would make her stop using only led to greater shame and self-harm, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the NICU. When Stephanie finally saw her her, she was hooked up to monitors, so small she thought she would harm her. Holding her for the first time, she felt empty. “I just stared 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 call her daughter Izzie, after the professional who provided support to her.

Nurses and doctors told her about Maddie’s Place, 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 identified with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like this facility is demonstrating a key fact: when mothers and babies stay together, results get better, foster placements fall and future expenses reduce.

It took Stephanie a period to find strength 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 collect her.

She left the medical center still in withdrawal, fearful and unsure about what would follow.

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At Maddie’s Place, Stephanie still was concerned that child services would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could walk in and take her baby away.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about getting by. Drugs 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 let her down. She was unable to love herself, let alone anyone else.

Daily, staff from the center transported her to a treatment center, provided orally. Slowly, 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 daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all typical problems for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. A support specialist, a peer support specialist, stopped by with her own children in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor 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. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a decoration on her head, seated on the ground with the exit nearby. She is lean. Her posture is humble so you cannot see her face. She is holding Izzie up on her knee for the other kids to see and they are gathered around, showing interest to the baby.

Jacob, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there if possible.

“Once I become a parent,” 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 became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I would become a mother.”

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Approaches for managing infants affected by substances have existed for decades.

The evaluation method was created in 1975|