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In her eighth month of pregnancy and suffering, a woman named Stephanie went to the ER after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and vomited.

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

She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had several weeks to find a way to become sober and have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the leg infection was serious, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

A short time later, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – early, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been given a few hours prior to birth.

She felt unwell. Unprepared to be a mother. Unworthy.

Stephanie had sought recovery several times during pregnancy, and felt terrible each time she relapsed. She felt worthless, berating herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her supplier would not provide to her when she became obviously with child.

“Yet I was unable,” she said. “I needed help.”

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

The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to tubes and leads, so tiny she thought she would hurt her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.

Medical personnel told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.

In numerous states, where a baby is identified with infant withdrawal condition regularly, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, outcomes improve, foster placements fall and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, care providers came to collect her.

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

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At the facility, Stephanie still was concerned that child services would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “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; reliance came last.

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to let her down. She lacked the ability to love herself, let alone anyone else.

Daily, staff from the facility took her to a recovery program, provided orally. Slowly, she was embracing sobriety.

She devoted all her time 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 intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a peer support specialist, stopped by with her own children in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She has an image of the moment. She is wearing casual attire, a beanie with a decoration on her head, sitting on the wooden floor with the door behind her. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her knee for the young ones to see and they are crowding near, showing interest to the baby.

One child, eight, asked the moms: “What about the fathers?” The women attempted to clarify 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. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I would become a mother.”

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Methods to address babies with exposure have existed for decades.

The assessment tool was developed in 1975|