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Eight months pregnant and in severe pain, a woman named Stephanie visited the ER after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and became sick.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to find a way to become sober and deliver her child.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced 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 drug that alleviates cravings and is frequently utilized in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie had a baby girl weighing 4lb 8oz – early, small but alive.

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

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

Stephanie had sought recovery repeatedly before birth, and felt awful each time she relapsed. She felt hopeless, blaming herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her dealer declined to supply to her when she became obviously with child.

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

The common assumption that her affection for her child would make her stop using only led to greater shame and self-abuse, 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 long-term illness.

The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to monitors, so little she thought she would harm her. Embracing her at last, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter Izzie, after the professional who provided support to her.

Hospital staff told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a small, growing network of centers like the care home is demonstrating a key fact: when parents and infants remain united, results get better, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to collect her.

She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.

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At the facility, Stephanie still was concerned that child services would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could arrive and remove her child.

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

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

Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to let her down. She was unable to care for herself, not to mention anyone else.

Every day, staff from Maddie’s Place drove her to a recovery program, given as medication. Over time, she was embracing sobriety.

She devoted all her time when not in sessions 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 occupational therapist – all typical problems for babies exposed to substances.

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

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a peer support specialist, stopped by with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The young ones stared in wonder 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 holds a picture of the moment. She is clad in black pants and a hoodie, a gray knit hat with a decoration on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you miss her features. She is presenting her daughter on her leg for the children to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could be a mom.”

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Methods to address drug-exposed newborns have been available for years.

The Finnegan NAS scale was established in 1975|