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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also addicted to fentanyl.

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

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had several weeks to figure out how to get clean and deliver her child.

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

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the leg infection was serious, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she departed, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

After five days, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – premature, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.

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

Stephanie had sought recovery multiple times while expecting, and felt terrible each time she relapsed. She felt hopeless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became clearly expecting.

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

The widespread belief that her bond with her newborn would make her stop using only led to increased guilt and negative self-talk, 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 chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to medical equipment, so tiny she thought she would harm her. Cradling her initially, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to call her daughter Izzie, after the attendant who showed compassion to her.

Medical personnel told her about a specialized facility, a innovative treatment home 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 newborn addiction symptoms frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to collect her.

She departed the institution still in withdrawal, scared and uncertain 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 not sure she wanted to keep her. The anxiety remained: that at any time, someone could enter and take her baby away.

For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about getting by. Substances came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to value herself, much less anyone else.

Daily, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Gradually, she was embracing sobriety.

She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – 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 could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a recovery coach, visited with her own family in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet 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. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in casual attire, a cap with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her face is downcast so you do not see her expression. She is presenting her daughter on her knee for the other kids to see and they are standing close, admiring and touching to the baby.

A young boy, eight, asked the moms: “Why are there no men?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if possible.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and the specialist made eye contact. “I just lost it and fell apart,” 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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Tools for treating babies with exposure have existed for decades.

The assessment tool was developed in 1975|