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Eight months pregnant and in severe pain, the expectant mother arrived at the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and became sick.

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

She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and have this baby.

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

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

After five days, on a day in November 2022, Stephanie had a infant weighing a small weight – early, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been provided a few hours prior to birth.

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

Stephanie had sought recovery multiple times while expecting, and felt terrible each time she relapsed. She felt worthless, criticizing herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her dealer would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her stop using only led to increased guilt and self-abuse, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the NICU. 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 empty. “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 the same as her nurse, after the professional who provided support to her.

Medical personnel told her about a care center, a unique recovery environment where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, recovery succeeds, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit 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 come next.

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At the care center, Stephanie still feared that child services would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could walk in and take her baby away.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about enduring. Substances came first; reliance came last.

Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to cause pain. She was unable to value herself, let alone anyone else.

Each day, staff from the center took her to a recovery program, administered in pill form. Over time, she was starting to get clean.

She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an professional – all typical problems for babies exposed to substances.

Seeing that even a young person understands the need for care, then I was capable. I could be a mom.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She holds a picture of the moment. She is dressed in casual attire, a gray knit hat with a bobble on her head, seated on the ground with the entryway at her back. She is thin. Her posture is humble so you do not see her expression. She is holding Izzie up on her knee for the other kids to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the dads were busy, called away to other tasks, that they would be there if possible.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I would become a mother.”

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Approaches for managing drug-exposed newborns have been used for a long time.

The assessment tool was created in 1975|