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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the ER after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had constructed in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and vomited.

Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before seeking medical help 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 critical, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing a small weight – premature, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.

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

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she failed. She felt worthless, berating herself for not being able to achieve the unattainable. 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 had to seek support.”

The widespread belief that her affection for her child would make her quit only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.

The infant was moved to the NICU. When Stephanie finally saw her her, she was attached to tubes and leads, so little she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Two days later she decided to name her baby after her caregiver, after the professional who provided support to her.

Medical personnel told her about a care center, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is identified with infant withdrawal condition regularly, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, foster placements fall and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She left the medical center still in recovery, anxious and doubtful about what would happen next.

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At the facility, Stephanie still was concerned that CPS would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could arrive and remove her child.

For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about survival. 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.

Every day, staff from the center took her to a recovery program, administered in pill form. Gradually, she was embracing sobriety.

She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a peer support specialist, came over with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a bobble on her head, seated on the ground with the entryway at her back. She is lean. Her face is downcast so you miss her features. She is holding Izzie up on her knee for the children to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the moms: “What about the fathers?” The parents responded that the men were occupied, called away to other tasks, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand 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 been used for a long time.

The assessment tool was developed in 1975|