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In her eighth month of pregnancy and suffering, the expectant mother went to the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a companion's property. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and threw up.

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

She had used fentanyl before coming to the ER and had only a brief window to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and have this baby.

The nurse had other ideas. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

After five days, on a day in November 2022, Stephanie had a infant weighing 4lb 8oz – born before term, small but alive.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been provided shortly before she gave birth.

She felt sick. Ill-equipped for parenting. Not fit.

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she was unsuccessful. She felt without value, blaming herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her supplier would not provide 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 recover only led to increased guilt and negative self-talk, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.

The infant was moved to the NICU. When Stephanie eventually visited her, she was connected to tubes and leads, so small she thought she would break her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

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

Medical personnel told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.

In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when families are kept intact, recovery succeeds, foster placements fall and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to collect her.

She departed the institution still in recovery, fearful and unsure about what would follow.

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At Maddie’s Place, Stephanie still was concerned that authorities would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could enter and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about enduring. Drugs came first; faith came last.

Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to cause pain. She was unable to value herself, much less anyone else.

Each day, staff from Maddie’s Place took 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 intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an specialist – all typical problems for babies born with NAS.

When a child recognizes these infants need affection, then I could do this. I could be a mom.

One afternoon before Thanksgiving, 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, stopped by with her own five kids in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration 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 keeps a photo of the moment. She is dressed in black pants and a hoodie, a cap with a pompom on her head, seated on the ground with the entryway at her back. She is lean. Her posture is humble so you cannot see her face. She is lifting the baby on her knee for the children to see and they are gathered around, 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.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I would become a mother.”

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Approaches for managing babies with exposure have been available for years.

The evaluation method was developed in 1975|