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In her eighth month of pregnancy and suffering, the expectant mother arrived at the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She slumped forward and became sick.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had a month remaining to figure out how to get clean and have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“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, Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

A short time later, on 12 November 2022, Stephanie gave birth to a daughter weighing a small weight – born before term, tiny yet healthy.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been administered shortly before she gave birth.

She felt ill. Ill-equipped for parenting. Not fit.

Stephanie had sought recovery several times during pregnancy, and felt awful each time she failed. She felt without value, berating herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her supplier declined to supply to her when she became visibly pregnant.

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

The common assumption that her bond with her newborn would make her quit only led to greater shame and self-abuse, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The infant was moved to the NICU. When Stephanie at last met her, she was connected to tubes and leads, so small she thought she would break her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to name her baby after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is demonstrating a key fact: when mothers and babies stay together, outcomes improve, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to pick her up.

She left the medical center still in withdrawal, scared and uncertain about what would happen next.

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At Maddie’s Place, Stephanie still was concerned that CPS would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could arrive and separate them.

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

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

Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She did not know how to care for herself, let alone anyone else.

Daily, staff from the center drove her to a treatment center, provided orally. Over time, she was starting to get clean.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all typical problems for babies exposed to substances.

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

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a recovery coach, visited with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She holds a picture of the moment. She is clad in black pants and a hoodie, a beanie with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her face is downcast so you cannot see her face. She is presenting her daughter on her lap for the other kids to see and they are standing close, admiring and touching to the baby.

A young boy, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could parent.”

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Methods to address infants affected by substances have been available for years.

The evaluation method was established in 1975|