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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. Without a job or home, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also addicted to fentanyl.

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

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

She had used fentanyl before coming to the ER and had only a brief window to get treated before she had to return to use once more. She thought she still had a month remaining to plan her recovery and have this baby.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.

A short time later, on a day in November 2022, Stephanie had a baby girl weighing 4lb 8oz – early, tiny yet healthy.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given a few hours prior to birth.

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

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer declined to supply to her when she became obviously with child.

“Yet I was unable,” she said. “I had to seek support.”

The widespread belief 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 just wish her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the NICU. When Stephanie at last met her, she was attached to tubes and leads, so little she thought she would hurt her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to name her baby Izzie, after the attendant who showed compassion to her.

Hospital staff 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 many parts of America, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, 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 stepped out of the hospital still in detox, scared and uncertain about what would follow.

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At Maddie’s Place, Stephanie still was concerned that CPS would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and separate them.

For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence 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 connection was tenuous. The individuals she cared for always found ways to let her down. She was unable to care for herself, let alone anyone else.

Each day, staff from the center transported her to a clinic for methadone, provided orally. Over time, she was beginning recovery.

She devoted all her time outside treatment 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 dietary support. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies born with NAS.

When a child recognizes these infants need affection, then I could do this. I could parent.

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, visited with her own five kids in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a decoration on her head, sitting on the wooden floor with the door behind her. She is lean. Her face is downcast so you cannot see her face. She is holding Izzie up on her lap for the young ones to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I would become a mother.”

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

The assessment tool was created in 1975|