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Pregnant and experiencing intense discomfort, a woman named Stephanie visited the medical facility after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had constructed in a companion's property. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”

She had consumed opioids before seeking medical help and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had several weeks to plan her recovery and give birth.

The attending nurse disagreed. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger 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 addiction recovery.

After five days, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – early, tiny yet healthy.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her epidural had failed, her last dose of fentanyl had been given shortly before she gave birth.

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

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she relapsed. She felt without value, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.

“However, I failed,” she said. “I required assistance.”

The pervasive expectation that her love for her baby would make her quit only led to greater shame and self-abuse, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would hurt her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What am I going to do with 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 attendant who showed compassion to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a developing system of centers like the care home is demonstrating a key fact: when parents and infants remain united, results get better, 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 confirming she would be a good fit for the program, care providers came to bring her to the facility.

She departed the institution 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 seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could enter and remove her child.

For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”

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

Stephanie had one close friend, but even that connection was tenuous. 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 facility drove her to a treatment center, given as medication. Over time, she was beginning recovery.

She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an specialist – all frequent conditions for babies exposed to substances.

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

One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. A support specialist, a mentor, stopped by with her own family in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a cap with a pompom on her head, resting on the floor with the entryway at her back. She is slender. Her posture is humble so you do not see her expression. She is presenting her daughter on her lap for the other kids to see and they are standing close, showing interest to the baby.

One child, eight, asked the moms: “Why are there no men?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there given the chance.

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

Stephanie and her companion exchanged glances. “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 could be a mom.”

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Methods to address drug-exposed newborns have existed for decades.

The Finnegan NAS scale was developed in 1975|