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Eight months pregnant and in severe pain, the expectant mother went to the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and threw up.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and deliver her child.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.

A short time later, on the 12th of November, Stephanie had a daughter weighing just over four pounds – born before term, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given a few hours prior to birth.

She felt unwell. Ill-equipped for parenting. Undeserving.

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she was unsuccessful. She felt worthless, berating herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier refused to sell 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 stop using only led to greater shame and self-abuse, a trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the NICU. When Stephanie at last met her, she was attached to monitors, so small she thought she would harm her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

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

Hospital staff told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In numerous states, 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 child-protection investigations. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, outcomes improve, fewer children enter care and long-term costs decline.

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, two staff members came to collect her.

She left the medical center still in withdrawal, anxious and doubtful about what would follow.

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At Maddie’s Place, Stephanie still was concerned that authorities would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could enter and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about survival. 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 lacked the ability to love herself, let alone anyone else.

Daily, staff from Maddie’s Place transported her to a clinic for methadone, provided orally. Slowly, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an specialist – all typical problems for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I was capable. I could be a mom.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. A support specialist, a mentor, visited with her own children in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The young ones stared in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast so you do not see her expression. She is lifting the baby on her leg for the other kids to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there if they could.

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

Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could be a mom.”

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Approaches for managing drug-exposed newborns have been used for a long time.

The evaluation method was established in 1975|