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Eight months pregnant and in severe pain, the expectant mother arrived at the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had constructed in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and threw up.

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

She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she had to return to get high again. 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 not allowed to leave.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the leg infection was serious, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

After five days, on a day in November 2022, Stephanie gave birth to a infant weighing a small weight – early, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was numb. Her pain relief did not work, her final administration of fentanyl had been given a few hours prior to birth.

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

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she relapsed. She felt without value, blaming herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her supplier declined to supply to her when she became visibly pregnant.

“But I couldn’t,” she said. “I had to seek support.”

The widespread belief that her love for her baby would make her recover only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was connected to monitors, so tiny she thought she would break her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to give her child the name Izzie, after the nurse who had been so kind to her.

Medical personnel told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.

In numerous states, where a baby is found to have newborn addiction symptoms regularly, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when families are kept intact, results get better, custody cases decrease and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to pick her up.

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

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

For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”

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

Stephanie had one close friend, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to love herself, much less anyone else.

Daily, staff from the center transported her to a recovery program, given as medication. Gradually, she was beginning recovery.

She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had sensory challenges and required an professional – all frequent conditions for babies born with NAS.

Seeing that even a young person understands the need for care, then I could do this. I could parent.

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for guided meetings with their babies. An advocate, a mentor, visited with her own family in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in admiration of the little newborn 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 keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, seated on the ground with the door behind her. She is thin. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her lap for the other kids to see and they are standing close, admiring and touching to the baby.

A young boy, eight, asked the moms: “Why are there no men?” The parents responded that the men were occupied, called away to other tasks, that they would be there if they could.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I would become a mother.”

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Tools for treating infants affected by substances have been available for years.

The evaluation method was established in 1975|