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In her eighth month of pregnancy and suffering, the expectant mother went to the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she lived in a shed she had built in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and became sick.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”

She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had four weeks left to find a way to become sober and give birth.

The nurse had other ideas. She told Stephanie she was staying put.

“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 leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.

She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

A short time later, on the 12th of November, Stephanie gave birth to a baby girl weighing just over four pounds – early, small but alive.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been given a few hours prior to birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier refused to sell to her when she became visibly pregnant.

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

The pervasive expectation 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 eliminate a chronic disease.

The newborn was transferred to the NICU. When Stephanie at last met her, she was hooked up to medical equipment, so small she thought she would hurt her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure 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 care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In numerous states, where a baby is found to have newborn addiction symptoms regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is proving a simple point: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to pick her up.

She departed the institution still in withdrawal, fearful and unsure about what would happen next.

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At the facility, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could arrive and remove her child.

For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about enduring. Drugs came first; reliance came last.

Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to care for herself, much less anyone else.

Every day, staff from Maddie’s Place drove her to a clinic for methadone, provided orally. Slowly, she was starting to get clean.

She spent every minute 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 pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all typical problems for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I could parent.

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a peer support specialist, stopped by with her own family in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a cap with a pompom on her head, seated on the ground with the door behind her. She is thin. Her face is downcast so you cannot see her face. She is lifting the baby on her leg for the other kids to see and they are crowding near, showing interest to the baby.

One child, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, 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 the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could parent.”

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Tools for treating babies with exposure have been used for a long time.

The assessment tool was established in 1975|