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In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at 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 built in a acquaintance's garden. She was also addicted to fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and threw up.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”

She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to find a way to become sober and give birth.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was critical, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.

A short time later, on the 12th of November, Stephanie had a daughter weighing just over four pounds – born before term, little but surviving.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been administered four hours before delivery.

She felt ill. Ill-equipped for parenting. Undeserving.

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she failed. She felt without value, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her dealer would not provide to her when she became clearly expecting.

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

The widespread belief that her love for her baby would make her stop using only led to greater shame and self-abuse, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to medical equipment, so little she thought she would hurt her. Holding her for the first time, she felt nothing. “I gazed upon 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 Izzie, after the attendant who showed compassion to her.

Medical personnel told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.

In much of the US, where a baby is found to have newborn addiction symptoms regularly, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she finally did. After confirming she would be a good fit for the program, care providers came to bring her to the facility.

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

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At the care center, Stephanie still feared that CPS would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and separate them.

For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Homelessness, she said, was about getting by. Substances came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to let her down. She was unable to care for herself, not to mention anyone else.

Every day, staff from the center transported her to a clinic for methadone, provided orally. Slowly, she was embracing sobriety.

She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an professional – all common issues for babies exposed to substances.

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

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, visited with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in awe 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 holds a picture of the moment. She is dressed in casual attire, a gray knit hat with a pompom on her head, seated on the ground with the door behind her. She is lean. Her head is tilted forward so you do not see her expression. She is lifting the baby on her knee for the other kids to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there if possible.

“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could be a mom.”

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Methods to address infants affected by substances have been available for years.

The assessment tool was developed in 1975|