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Eight months pregnant and in severe pain, a woman named Stephanie arrived at the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had built in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and vomited.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she needed to go home to relapse. She thought she still had a month remaining to find a way to become sober and give birth.

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

“I will go,” Stephanie said.

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

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

After five days, on a day in November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, tiny yet healthy.

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

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

Stephanie had sought recovery repeatedly before birth, and felt awful each time she relapsed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her supplier declined to supply to her when she became obviously with child.

“But I couldn’t,” she said. “I required assistance.”

The pervasive expectation that her affection for her child would make her quit only led to greater shame and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.

The infant was moved to the NICU. When Stephanie finally saw her her, she was hooked up to monitors, so little she thought she would break her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

After two days she decided to call her daughter Izzie, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a unique recovery environment where women and their babies are cared for jointly, not apart.

In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a developing system of centers like this facility is proving a simple point: when families are kept intact, results get better, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to pick her up.

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

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At Maddie’s Place, Stephanie still was concerned that CPS would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could arrive and remove her child.

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.”

Homelessness, she said, was about survival. Addiction came first; reliance came last.

Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She did not know how to care for herself, not to mention anyone else.

Every day, staff from the facility drove her to a recovery program, provided orally. Slowly, she was embracing sobriety.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an specialist – all frequent conditions for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. A support specialist, a mentor, stopped by with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a cap with a decoration on her head, seated on the ground with the door behind her. She is slender. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her leg for the young ones to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the moms: “Why are there no men?” The parents responded that the dads were busy, called away to other tasks, that they would be there if possible.

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

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I would become a mother.”

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Methods to address drug-exposed newborns have been used for a long time.

The assessment tool was established in 1975|