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Eight months pregnant and in severe pain, the expectant mother visited the hospital emergency room after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

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

She had consumed opioids before seeking medical help and had just enough time to get treated before she had to return to get high again. 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 allowed to leave.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the leg infection was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

Five days later, on 12 November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – born before term, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered shortly before she gave birth.

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

Stephanie had tried to get clean several times during pregnancy, and felt awful each time she was unsuccessful. She felt without value, berating herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became visibly pregnant.

“However, I failed,” she said. “I required assistance.”

The pervasive expectation that her love for her baby would make her recover only led to increased guilt and self-harm, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could will away a persistent condition.

The baby was taken to the NICU. When Stephanie eventually visited her, she was connected to monitors, so tiny she thought she would harm her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to collect her.

She departed the institution still in detox, fearful and unsure about what would happen next.

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At the care center, Stephanie still worried that authorities would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could arrive and separate them.

For the initial fortnight, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about getting by. Drugs came first; reliance came last.

Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to value herself, much less anyone else.

Each day, staff from Maddie’s Place drove her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.

She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all typical problems for babies exposed to substances.

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

One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for supervised visits with their babies. An advocate, a mentor, came over with her own five kids in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the little newborn 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 dressed in casual attire, a beanie with a decoration on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you cannot see her face. She is lifting the baby on her leg for the children to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the dads were busy, 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. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could be a mom.”

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Methods to address babies with exposure have been used for a long time.

The evaluation method was created in 1975|