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In her eighth month of pregnancy and suffering, the expectant mother went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had constructed in a companion's property. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and became sick.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had used fentanyl before seeking medical help and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to figure out how to get clean and deliver her child.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was critical, but doctors had discovered 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 regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

After five days, on a day in November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – early, tiny yet healthy.

When the nurse asked if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.

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

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I required assistance.”

The pervasive expectation that her bond with her newborn would make her quit only led to deeper self-loathing and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was hooked up to medical equipment, so tiny she thought she would break her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to call her daughter Izzie, after the nurse who had been so kind to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where women and their babies are supported as a unit, not apart.

In much of the US, where a baby is identified with newborn addiction symptoms regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like this facility is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to pick her up.

She left the medical center still in detox, fearful and unsure about what would happen next.

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At the care center, Stephanie still feared that authorities 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 enter and separate them.

For the first two weeks, Stephanie remained isolated. “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 getting by. Drugs came first; trust came last.

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She did not know how to value herself, not to mention anyone else.

Every day, staff from Maddie’s Place drove her to a clinic for methadone, 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 daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. An advocate, a peer support specialist, came over with her own family in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a bobble on her head, resting on the floor with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is lifting the baby on her lap for the children to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, engaged elsewhere, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I would become a mother.”

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Tools for treating babies with exposure have been available for years.

The Finnegan NAS scale was created in 1975|