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Eight months pregnant and in severe pain, the expectant mother visited the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had constructed in a companion's property. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and threw up.

Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had several weeks to plan her recovery and give birth.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.

A short time later, on a day in November 2022, Stephanie delivered a daughter weighing a small weight – early, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been provided shortly before she gave birth.

She felt ill. Unprepared to be a mother. Undeserving.

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she relapsed. She felt without value, blaming herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her dealer would not provide to her when she became clearly expecting.

“Yet I was unable,” she said. “I needed help.”

The widespread belief that her affection for her child would make her recover only led to greater shame and negative self-talk, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.

The newborn was transferred to the special care nursery. When Stephanie at last met her, she was connected to monitors, so little she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

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

Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like the care home is proving a simple point: when mothers and babies stay together, results get better, foster placements fall and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to collect her.

She stepped out of the hospital still in detox, scared and uncertain about what would follow.

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At the facility, Stephanie still was concerned that child services would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and separate them.

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

Survival outdoors, she said, was about enduring. Drugs came first; trust came last.

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to let her down. She was unable to love herself, much less anyone else.

Every day, staff from the center transported her to a recovery program, administered in pill form. Gradually, she was embracing sobriety.

She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. 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 could do this. I could parent.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a mentor, visited with her own family in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The young ones stared in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She has an image of the moment. She is dressed in black pants and a hoodie, a beanie with a pompom on her head, sitting on the wooden floor with the door behind her. She is slender. Her face is downcast so you miss her features. She is presenting her daughter on her knee for the children to see and they are crowding near, fawning and reaching out to the baby.

A young boy, eight, asked the moms: “Why are there no men?” The moms tried to explain that the fathers had obligations, 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 will teach them about love.”

Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I was able. I could be a mom.”

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

The Finnegan NAS scale was developed in 1975|