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Pregnant and experiencing intense discomfort, a woman named Stephanie visited the hospital emergency room 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 constructed in a companion's property. She was also dependent on fentanyl.

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

Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”

She had taken the drug before seeking medical help and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to plan her recovery and have this baby.

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

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.

Five days later, on 12 November 2022, Stephanie delivered a infant weighing just over four pounds – premature, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been provided a few hours prior to birth.

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

Stephanie had sought recovery repeatedly before birth, and felt awful each time she failed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her source refused to sell to her when she became clearly expecting.

“However, I failed,” she said. “I needed help.”

The pervasive expectation that her affection for her child would make her recover only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the NICU. When Stephanie at last met her, she was connected to monitors, so small she thought she would hurt her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to give her child the name Izzie, after the nurse who had been so kind to her.

Medical personnel told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a developing system of centers like the care home is demonstrating a key fact: when mothers and babies stay together, results get better, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She left the medical center still in withdrawal, anxious and doubtful about what would happen next.

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At Maddie’s Place, Stephanie still worried that authorities would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and take her baby away.

For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to care for herself, let alone anyone else.

Daily, staff from the facility transported her to a recovery program, given as medication. Gradually, she was starting to get clean.

She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an professional – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I could be a mom.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a peer support specialist, came over with her own five kids in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She holds a picture of the moment. She is clad in casual attire, a gray knit hat with a bobble on her head, seated on the ground with the entryway at her back. She is lean. Her face is downcast so you do not see her expression. She is lifting the baby on her knee for the children to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the men were occupied, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could parent.”

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Tools for treating infants affected by substances have been available for years.

The Finnegan NAS scale was developed in 1975|