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In her eighth month of pregnancy and suffering, the expectant mother visited the hospital emergency room 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 friend’s yard. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had taken the drug before seeking medical help and had only a brief window to get treated before she needed to go home to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie delivered a daughter weighing a small weight – early, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been provided four hours before delivery.

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

Stephanie had sought recovery several times during pregnancy, and felt terrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source declined to supply to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her recover only led to increased guilt and self-harm, 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 NICU. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would harm her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt 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.

Medical personnel told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is showing an important truth: when families are kept intact, recovery succeeds, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, two staff members came to bring her to the facility.

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

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At Maddie’s Place, Stephanie still worried that authorities would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could walk in and take her baby away.

For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about getting by. Substances came first; reliance came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to hurt her. She did not know how to love herself, much less anyone else.

Each day, staff from Maddie’s Place drove her to a clinic for methadone, given as medication. Gradually, she was embracing sobriety.

She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had sensory challenges and required an professional – all frequent conditions for babies born with NAS.

Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.

During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own children in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is dressed in casual attire, a gray knit hat with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg 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 men were occupied, engaged elsewhere, that they would be there given the chance.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I would become a mother.”

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

The Finnegan NAS scale was created in 1975|