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Eight months pregnant and in severe pain, a woman named Stephanie visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and became sick.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”

She had consumed opioids before coming to the ER 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 figure out how to get clean and deliver her child.

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

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

A short time later, on the 12th of November, Stephanie gave birth to a infant weighing just over four pounds – premature, little but surviving.

When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been provided four hours before delivery.

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

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her supplier would not provide to her when she became visibly pregnant.

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

The common assumption that her love for her baby would make her recover only led to deeper self-loathing and self-abuse, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would harm her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

After two days she decided to give her child the name after her caregiver, 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 cared for jointly, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, results get better, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to pick her up.

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

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At the care center, Stephanie still feared that CPS would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter 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 lacked confidence at that point.”

Life on the streets, she said, was about enduring. Addiction came first; reliance came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to cause pain. She was unable to care for herself, much less anyone else.

Every day, staff from the facility took her to a recovery program, provided orally. Over time, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. 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 could do this. I could be a mom.

On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. A support specialist, a recovery coach, stopped by with her own five kids in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a cap with a decoration on her head, resting on the floor with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are gathered around, admiring and touching to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if possible.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I would become a mother.”

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Methods to address drug-exposed newborns have been used for a long time.

The evaluation method was created in 1975|