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Pregnant and experiencing intense discomfort, the expectant mother went to the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had built in a companion's property. She was also hooked on fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and give birth.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the leg infection was critical, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – early, small but alive.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been administered four hours before delivery.

She felt ill. Unprepared to be a mother. Not fit.

Stephanie had sought recovery several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, blaming herself for not being able to do the impossible. An obstetrician told her to “just” stop using. Even her dealer would not provide to her when she became obviously with child.

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

The pervasive expectation that her affection for her child would make her stop using only led to deeper self-loathing and negative self-talk, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.

The baby was taken to the NICU. When Stephanie eventually visited her, she was hooked up to monitors, so little she thought she would break her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Two days later she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about Maddie’s Place, a innovative treatment home where women and their babies are cared for jointly, not apart.

In numerous states, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, results get better, custody cases decrease 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, two staff members came to bring her to the facility.

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

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At the facility, Stephanie still was concerned that child services would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and take her baby away.

For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about survival. Substances came first; faith came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She lacked the ability to value herself, let alone anyone else.

Every day, staff from Maddie’s Place transported her to a clinic for methadone, given as medication. Slowly, she was embracing sobriety.

She devoted all her time beyond therapy 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 pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an professional – all typical problems for babies born with NAS.

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

During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing casual attire, a beanie with a pompom on her head, seated on the ground with the entryway at her back. She is slender. Her posture is humble so you miss her features. She is lifting the baby on her knee for the other kids to see and they are standing close, fawning and reaching out to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could be a mom.”

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Methods to address infants affected by substances have existed for decades.

The evaluation method was developed in 1975|