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Pregnant and experiencing intense discomfort, the expectant mother visited the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had constructed in a companion's property. She was also dependent on fentanyl.

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

Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”

She had consumed opioids 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 four weeks left to figure out how to get clean and deliver her child.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

After five days, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – early, little but surviving.

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

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

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her source declined to supply to her when she became visibly pregnant.

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

The common assumption that her affection for her child would make her stop using only led to greater shame and negative self-talk, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was hooked up to monitors, so little she thought she would break her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

After two days she decided to name her baby after her caregiver, after the professional who provided support to her.

Medical personnel told her about a care center, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to collect her.

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

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At the care center, Stephanie still feared that authorities would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could enter and take her baby away.

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

Survival outdoors, she said, was about survival. Substances came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to value herself, not to mention anyone else.

Daily, staff from Maddie’s Place drove her to a recovery program, provided orally. Slowly, she was embracing sobriety.

She utilized each moment 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 intolerance to some formulas and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. A support specialist, a peer support specialist, came over with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet 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. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a cap with a bobble on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you miss her features. 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.

One child, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there given the chance.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I would become a mother.”

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Methods to address babies with exposure have existed for decades.

The evaluation method was developed in 1975|