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In her eighth month of pregnancy and suffering, the expectant mother visited the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had constructed in a companion's property. She was also dependent on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

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

She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home to relapse. She thought she still had four weeks left to plan her recovery and have this baby.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

After five days, on a day in November 2022, Stephanie delivered a infant weighing 4lb 8oz – early, small but alive.

When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been administered shortly before she gave birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her dealer declined to supply to her when she became obviously with child.

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

The pervasive expectation that her bond with her newborn would make her quit only led to increased guilt and self-abuse, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and given drugs 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 families are kept intact, recovery succeeds, foster placements fall 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, care providers came to collect her.

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

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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 point, someone could arrive and take her baby away.

For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about survival. Drugs came first; reliance came last.

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

Each day, staff from Maddie’s Place drove her to a recovery program, provided orally. Gradually, she was beginning recovery.

She spent every minute outside treatment 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 pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an specialist – 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.

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, came over with her own children in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She holds a picture of the moment. She is wearing casual attire, a cap with a bobble on her head, resting on the floor with the entryway at her back. She is lean. Her head is tilted forward so you cannot see her face. She is lifting the baby on her leg for the children to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. 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. “Seeing that even youth understand that newborns require care, then I found the courage. I could be a mom.”

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Tools for treating babies with exposure have existed for decades.

The assessment tool was developed in 1975|