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Eight months pregnant and in severe pain, the expectant mother went to the ER after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before arriving at the hospital and had just enough time to get treated before she needed to go home to relapse. She thought she still had a month remaining to find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was serious, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.

After five days, on the 12th of November, Stephanie delivered a baby girl weighing 4lb 8oz – born before term, small but alive.

When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.

She felt sick. Unprepared to be a mother. Unworthy.

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she failed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier declined to supply to her when she became obviously with child.

“Yet I was unable,” she said. “I needed help.”

The pervasive expectation that her affection for her child would make her recover only led to greater shame and negative self-talk, a cause 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 baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to monitors, so tiny she thought she would harm her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

After two days she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.

Nurses and doctors told her about a care center, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is showing an important truth: when families are kept intact, outcomes improve, custody cases decrease and long-term costs decline.

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 detox, fearful and unsure about what would come next.

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At the care center, Stephanie still worried that authorities would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could arrive and remove her child.

For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

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

Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to let her down. She did not know how to care for herself, much less anyone else.

Every day, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Over time, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is clad in casual attire, a beanie with a decoration on her head, seated on the ground with the exit nearby. She is slender. Her posture is humble so you cannot see her face. She is holding Izzie up on her knee for the other kids to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the parents: “Where are all the dads?” The parents responded that the men were occupied, called away to other tasks, that they would be there given the chance.

“When I have kids,” 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 could do this. I could parent.”

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Methods to address drug-exposed newborns have been used for a long time.

The assessment tool was established in 1975|