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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and became sick.

Stephanie finally broke down. “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 sufficient opportunity 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 deliver her child.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.

A short time later, on a day in November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – born before term, small but alive.

When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her epidural had failed, her last dose of fentanyl had been administered a few hours prior to birth.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had sought recovery repeatedly before birth, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her supplier refused to sell to her when she became obviously with child.

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

The widespread belief that her bond with her newborn would make her recover only led to greater shame and self-abuse, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the NICU. When Stephanie at last met her, she was attached to tubes and leads, so little she thought she would harm her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to call her daughter after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, care providers came to pick her up.

She stepped out of the hospital still in detox, anxious and doubtful about what would follow.

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At Maddie’s Place, Stephanie still was concerned that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could arrive and take her baby away.

For the initial fortnight, Stephanie remained isolated. “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 enduring. Drugs came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to let her down. She did not know how to value herself, not to mention anyone else.

Every day, staff from the facility drove her to a treatment center, administered in pill form. Gradually, she was embracing sobriety.

She devoted all her time 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 intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I could parent.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own children in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared 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. They focused only on the baby.”

She has an image of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast so you do not see her expression. She is presenting her daughter on her knee for the other kids to see and they are standing close, showing interest to the baby.

One child, eight, asked the parents: “Why are there no men?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there given the chance.

“When I have kids,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could parent.”

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Approaches for managing babies with exposure have been available for years.

The evaluation method was developed in 1975|