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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 constructed in a companion's property. She was also dependent on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and threw up.

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

She had used fentanyl before coming to the ER and had only a brief window to get treated before she needed to go home to relapse. She thought she still had several weeks to find a way to become sober 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 critical, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

After five days, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – premature, small but alive.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.

She felt unwell. Unprepared to be a mother. Not fit.

Stephanie had sought recovery repeatedly before birth, and felt awful each time she failed. She felt worthless, berating herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her dealer refused to sell to her when she became clearly expecting.

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

The pervasive expectation that her bond with her newborn would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would hurt her. Embracing her at last, she felt detached. “I gazed upon 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 call her daughter Izzie, after the attendant who showed compassion 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 rushed to special care and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is proving a simple point: when mothers and babies stay together, outcomes improve, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she finally did. 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 recovery, fearful and unsure about what would happen next.

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At the care center, Stephanie still feared that child services would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could arrive and remove her child.

For the beginning period, Stephanie kept to herself. “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. Substances came first; faith came last.

Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She was unable to love herself, let alone anyone else.

Daily, staff from the center drove her to a treatment center, provided orally. Slowly, she was starting to get clean.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an professional – all typical problems for babies affected by withdrawal.

When a child recognizes these infants need affection, then I was capable. I could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a recovery coach, came over with her own five kids in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in wonder of the small baby 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 keeps a photo of the moment. She is wearing casual attire, a cap with a decoration on her head, resting on the floor with the entryway at her back. She is lean. Her face is downcast so you cannot see her face. 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.

One child, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I could be a mom.”

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

The evaluation method was developed in 1975|