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Pregnant and experiencing intense discomfort, the expectant mother visited the ER after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had built in a friend’s yard. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”

She had used fentanyl before coming to the ER 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 figure out how to get clean and have this baby.

The medical professional intervened. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was critical, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie gave birth to a daughter weighing just over four pounds – early, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been administered a few hours prior to birth.

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

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she failed. She felt worthless, criticizing herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became visibly pregnant.

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

The common assumption that her affection for her child would make her quit only led to greater shame and self-abuse, a cause 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 neonatal intensive care unit. When Stephanie finally saw her her, she was connected to medical equipment, so little she thought she would harm her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

After two days she decided to name her baby after her caregiver, after the nurse who had been so kind to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like the care home is demonstrating a key fact: when parents and infants remain united, recovery succeeds, foster placements fall and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, care providers came to bring her to the facility.

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

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At Maddie’s Place, Stephanie still worried that CPS would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could walk in and remove her child.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She lacked the ability to value herself, let alone anyone else.

Daily, staff from the facility transported her to a clinic for methadone, administered in pill form. Over time, she was embracing sobriety.

She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” 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 cap 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 do not see her expression. She is holding Izzie up on her knee for the other kids to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there given the chance.

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

Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I would become a mother.”

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Tools for treating babies with exposure have been available for years.

The Finnegan NAS scale was created in 1975|