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Pregnant and experiencing intense discomfort, a woman named Stephanie went to the ER after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had built in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and became sick.

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

She had used fentanyl before seeking medical help and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to find a way to become sober and have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the leg infection was critical, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.

A short time later, on 12 November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – early, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was detached. Her epidural had failed, her previous intake of fentanyl had been given four hours before delivery.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had sought recovery repeatedly before birth, and felt awful each time she was unsuccessful. She felt worthless, berating herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her supplier refused to sell to her when she became obviously with child.

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

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

The baby was taken to the NICU. When Stephanie finally saw her her, she was hooked up to tubes and leads, so tiny she thought she would harm her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.

Hospital staff told her about Maddie’s Place, a new kind of care center where women and their babies are treated together, not apart.

In much of the US, where a baby is identified with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a developing system of centers like this facility is demonstrating a key fact: when mothers and babies stay together, results get better, foster placements fall 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 pick her up.

She departed the institution still in recovery, anxious and doubtful about what would follow.

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At the facility, Stephanie still feared that authorities would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could walk in and remove her child.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about enduring. Substances came first; reliance came last.

Stephanie had one close friend, 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.

Daily, staff from the facility drove her to a clinic for methadone, provided orally. Slowly, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an occupational therapist – all common issues for babies affected by withdrawal.

When a child recognizes these infants need affection, then I found the strength. I could parent.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a recovery coach, stopped by 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 awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She has an image of the moment. She is wearing casual attire, a gray knit hat with a bobble on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast 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 parents: “What about the fathers?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there if they could.

“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 made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could parent.”

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Approaches for managing babies with exposure have been used for a long time.

The evaluation method was developed in 1975|