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Eight months pregnant and in severe pain, the expectant mother arrived at the ER after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had constructed in a companion's property. She was also dependent on fentanyl.

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

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

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to plan her recovery and deliver her child.

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

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection was severe, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.

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

When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been given four hours before delivery.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had sought recovery several times during pregnancy, and felt awful each time she relapsed. She felt hopeless, criticizing 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 obviously with child.

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

The common assumption that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was attached to tubes and leads, so tiny she thought she would hurt her. Cradling her initially, she felt detached. “I gazed upon 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 call her daughter Izzie, after the professional who provided support to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where women and their babies are supported as a unit, not apart.

In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like this facility is showing an important truth: when mothers and babies stay together, recovery succeeds, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to collect her.

She stepped out of the hospital still in detox, anxious and doubtful about what would happen next.

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At Maddie’s Place, Stephanie still feared that authorities would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could arrive and take her baby away.

For the initial fortnight, Stephanie remained isolated. “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.”

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

Every day, staff from the facility drove her to a clinic for methadone, provided orally. Slowly, she was beginning recovery.

She devoted all her time outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all typical problems for babies born with NAS.

When a child recognizes these infants need affection, then I could do this. I could be a mom.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. An advocate, a mentor, stopped by with her own children in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She has an image of the moment. She is wearing casual attire, a cap with a decoration on her head, seated on the ground with the door behind her. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her lap for the young ones to see and they are standing close, showing interest to the baby.

One child, eight, asked the parents: “Where are all the dads?” The parents responded that the men were occupied, handling responsibilities, that they would be there given the chance.

“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I would become a mother.”

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Tools for treating babies with exposure have existed for decades.

The assessment tool was created in 1975|