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Eight months pregnant and in severe pain, 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 built in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and have this baby.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, 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 at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – born before term, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been given shortly before she gave birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt without value, blaming herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her supplier refused to sell to her when she became clearly expecting.

“Yet I was unable,” she said. “I required assistance.”

The widespread belief that her bond with her newborn would make her recover only led to deeper self-loathing and self-harm, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a persistent condition.

The infant was moved to the NICU. When Stephanie eventually visited her, she was attached to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to give her child the name the same as her nurse, after the professional who provided support to her.

Hospital staff told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.

In numerous states, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, care providers came to pick her up.

She departed the institution still in recovery, scared and uncertain about what would come next.

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At the care center, Stephanie still feared that CPS would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and take her baby away.

For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about getting by. Drugs came first; reliance came last.

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She was unable to love herself, much less anyone else.

Each day, staff from Maddie’s Place drove her to a clinic for methadone, given as medication. Over time, she was beginning recovery.

She utilized each moment 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 obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an specialist – all common issues for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed 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. They focused only on the baby.”

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 slender. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her knee for the other kids to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if possible.

“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I could parent.”

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Methods to address babies with exposure have been available for years.

The evaluation method was created in 1975|