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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and threw up.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”

She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had several weeks to find a way to become sober and give birth.

The medical professional intervened. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie delivered a daughter weighing 4lb 8oz – early, tiny yet healthy.

When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been given a few hours prior to birth.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she was unsuccessful. She felt hopeless, berating herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her supplier would not provide to her when she became clearly expecting.

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

The pervasive expectation that her affection for her child would make her quit only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was connected to medical equipment, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.

Hospital staff told her about Maddie’s Place, a new kind of care center 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) regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like this facility is proving a simple point: when mothers and babies stay together, results get better, custody cases decrease and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to pick her up.

She left the medical center still in recovery, fearful and unsure about what would come next.

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At Maddie’s Place, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any time, someone could arrive and separate them.

For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about enduring. Substances came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to value herself, let alone anyone else.

Every day, staff from the center drove her to a treatment center, given as medication. Gradually, she was embracing sobriety.

She utilized each moment beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an professional – all common issues for babies born with NAS.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in black pants and a hoodie, a beanie with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her posture is humble so you do not see her expression. She is holding Izzie up on her knee for the young ones to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the moms: “What about the fathers?” The moms tried to explain that the fathers had obligations, handling responsibilities, 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 her companion looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I could be a mom.”

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Approaches for managing infants affected by substances have been used for a long time.

The Finnegan NAS scale was developed in 1975|