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In her eighth month of pregnancy and suffering, the expectant mother visited the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had assembled in a companion's property. She was also addicted to fentanyl.

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

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital 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 medical professional intervened. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.

A short time later, on a day in November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – early, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been given a few hours prior to birth.

She felt ill. Unprepared to be a mother. Unworthy.

Stephanie had sought recovery multiple times while expecting, and felt awful each time she failed. She felt without value, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her dealer refused to sell to her when she became clearly expecting.

“Yet I was unable,” she said. “I had to seek support.”

The pervasive expectation that her love for her baby would make her stop using only led to greater shame and self-harm, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to tubes and leads, so small she thought she would harm her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain 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.

Medical personnel told her about a specialized facility, a new kind of care center where women and their babies are cared for jointly, not apart.

In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, results get better, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.

She stepped out of the hospital still in withdrawal, anxious and doubtful about what would follow.

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

For the initial fortnight, 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 survival. Drugs came first; reliance came last.

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to hurt her. She lacked the ability to value herself, let alone anyone else.

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

She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a recovery coach, came over with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, seated on the ground with the entryway at her back. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her knee for the young ones to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The parents responded that the dads were busy, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I found the courage. I could parent.”

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Methods to address infants affected by substances have been used for a long time.

The evaluation method was developed in 1975|