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Eight months pregnant and in severe pain, the expectant mother arrived at the medical facility after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built in a companion's property. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and became sick.

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

She had consumed opioids 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 four weeks left to figure out how to get clean and give birth.

The attending nurse disagreed. 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 severe, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.

Five days later, on a day in November 2022, Stephanie had a infant weighing just over four pounds – premature, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her epidural had failed, her last dose of fentanyl had been provided four hours before delivery.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had sought recovery several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her affection for her child would make her quit only led to greater shame and negative self-talk, a cause 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 at last met her, she was attached to monitors, so little she thought she would break her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.

In much of the US, where a baby is identified with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is showing an important truth: when families are kept intact, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, two staff members came to pick her up.

She left the medical center still in recovery, anxious and doubtful about what would follow.

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At Maddie’s Place, Stephanie still feared that child services would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and separate them.

For the beginning period, Stephanie remained isolated. “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.”

Homelessness, she said, was about getting by. Drugs came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. 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 the center transported her to a recovery program, provided orally. Slowly, she was beginning recovery.

She spent every minute outside treatment 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 obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

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

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed 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 has an image of the moment. She is wearing dark trousers and a sweatshirt, a cap with a bobble on her head, resting on the floor with the exit nearby. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the children to see and they are crowding near, admiring and touching to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I would become a mother.”

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Tools for treating infants affected by substances have been used for a long time.

The Finnegan NAS scale was established in 1975|