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In her eighth month of pregnancy and suffering, the expectant mother visited the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had assembled in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and vomited.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before seeking medical help and had just enough time to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and have this baby.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection was critical, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – premature, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her pain relief did not work, her last dose of fentanyl had been provided shortly before she gave birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her source declined to supply to her when she became obviously with child.

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

The widespread belief that her love for her baby would make her stop using only led to deeper self-loathing and negative self-talk, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.

The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to monitors, so tiny she thought she would break her. Holding her for the first time, she felt nothing. “I looked at 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 after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about Maddie’s Place, a innovative treatment home where mothers and their drug-exposed newborns are treated together, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition frequently, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is proving a simple point: when families are kept intact, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to pick her up.

She left the medical center still in detox, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could enter and separate them.

For the first two weeks, Stephanie remained isolated. “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. Substances came first; faith came last.

Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to cause pain. She did not know how to value herself, let alone anyone else.

Every day, staff from the center took her to a recovery program, provided orally. Gradually, 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 infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I was capable. I would become a mother.

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is clad in black pants and a hoodie, a beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her head is tilted forward so you miss her features. She is holding Izzie up on her lap for the other kids to see and they are gathered around, fawning and reaching out to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if possible.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could parent.”

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Tools for treating drug-exposed newborns have existed for decades.

The Finnegan NAS scale was created in 1975|