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Pregnant and experiencing intense discomfort, a woman named Stephanie visited the hospital emergency room after her infection worsened up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had assembled in a companion's property. She was also dependent on fentanyl.

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

Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”

She had taken the drug before seeking medical help and had just enough time to get treated before she had to return to use once more. She thought she still had a month remaining to plan her recovery and have this baby.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was critical, but physicians found 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 regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie delivered a infant weighing just over four pounds – premature, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was numb. Her epidural had failed, her previous intake of fentanyl had been provided shortly before she gave birth.

She felt ill. Not ready for motherhood. Undeserving.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “simply” stop using. Even her supplier would not provide to her when she became visibly pregnant.

“Yet I was unable,” she said. “I required assistance.”

The widespread belief that her bond with her newborn would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the special care nursery. When Stephanie eventually visited her, she was hooked up to tubes and leads, so small she thought she would break her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to name her baby after her caregiver, after the attendant who showed compassion to her.

Hospital staff told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, care providers came to collect her.

She stepped out of the hospital still in detox, anxious and doubtful about what would come next.

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At the care center, Stephanie still feared that authorities would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could enter and take her baby away.

For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

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

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to let her down. She was unable to love herself, much less anyone else.

Every day, staff from Maddie’s Place drove her to a clinic for methadone, provided orally. Gradually, she was embracing sobriety.

She devoted all her time 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 adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an professional – all common issues for babies exposed to substances.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a recovery coach, visited with her own children in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is wearing black pants and a hoodie, a gray knit hat with a decoration on her head, sitting on the wooden floor with the exit nearby. She is lean. Her head is tilted forward so you do not see her expression. She is lifting the baby on her lap for the other kids to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there given the chance.

“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could be a mom.”

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Approaches for managing infants affected by substances have existed for decades.

The Finnegan NAS scale was created in 1975|