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Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the ER after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had constructed in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and threw up.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had a month remaining to find a way to become sober and deliver her child.

The medical professional intervened. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the doctors would not let her go: the infection in her legs was critical, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

A short time later, on a day in November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.

She felt ill. Ill-equipped for parenting. Not fit.

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, berating herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her source would not provide to her when she became visibly pregnant.

“But I couldn’t,” she said. “I required assistance.”

The widespread belief that her affection for her child would make her stop using only led to greater shame and self-harm, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The infant was moved to the NICU. When Stephanie eventually visited her, she was connected to monitors, so tiny 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.

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

Nurses and doctors told her about a care center, a innovative treatment home where women and their babies are treated together, not apart.

In numerous states, 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 developing system of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, results get better, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to collect her.

She stepped out of the hospital still in recovery, fearful and unsure about what would follow.

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At the facility, Stephanie still worried that child services would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could walk in and take her baby away.

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

Homelessness, she said, was about survival. Drugs came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The people she loved always found ways to let her down. She did not know how to care for herself, much less anyone else.

Daily, staff from the facility drove her to a treatment center, provided orally. Slowly, she was starting to get clean.

She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies exposed to substances.

Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.

During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in admiration 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 beanie with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her knee for the other kids to see and they are gathered around, fawning and reaching out to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there if possible.

“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I would become a mother.”

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

The Finnegan NAS scale was developed in 1975|