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In her eighth month of pregnancy and suffering, a woman named Stephanie 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 built in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and became sick.

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

She had taken the drug before coming to the ER and had only a brief window to get treated before she had to return to relapse. She thought she still had several weeks to figure out how to get clean and deliver her child.

The medical professional intervened. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was serious, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

After five days, on 12 November 2022, Stephanie had a baby girl weighing just over four pounds – early, 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 a few hours prior to birth.

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

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she failed. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her source would not provide to her when she became visibly pregnant.

“However, I failed,” she said. “I had to seek support.”

The widespread belief that her love for her baby would make her recover only led to greater shame and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the NICU. When Stephanie at last met her, she was connected to tubes and leads, so small she thought she would harm her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

After two days she decided to give her child the name the same as her nurse, after the professional who provided support to her.

Nurses and doctors told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is identified with newborn addiction symptoms regularly, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, outcomes improve, custody cases decrease and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to bring her to the facility.

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

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At Maddie’s Place, Stephanie still worried that child services would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, 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 was suspicious at that point.”

Homelessness, she said, was about getting by. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She lacked the ability to value herself, much less anyone else.

Daily, staff from the center transported her to a clinic for methadone, administered in pill form. Gradually, she was starting to get clean.

She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies affected by withdrawal.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a mentor, visited with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

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

She keeps a photo of the moment. She is dressed in casual attire, a gray knit hat with a pompom on her head, resting on the 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 children to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could parent.”

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Methods to address drug-exposed newborns have existed for decades.

The evaluation method was created in 1975|