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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had built in a friend’s yard. She was also dependent on fentanyl.

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

Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had four weeks left to find a way to become sober and have this baby.

The medical professional intervened. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

After five days, on the 12th of November, Stephanie had a infant weighing a small weight – premature, small but alive.

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

She felt unwell. Unprepared to be a mother. Unworthy.

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her supplier would not provide to her when she became obviously with child.

“But I couldn’t,” she said. “I required assistance.”

The common assumption that her affection for her child would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would break her. Cradling her initially, she felt empty. “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.

Two days later she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.

Medical personnel told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to bring her to the facility.

She stepped out of the hospital still in withdrawal, scared and uncertain about what would happen next.

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

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

Homelessness, she said, was about survival. Substances came first; faith came last.

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to value herself, let alone anyone else.

Every day, staff from the facility took her to a recovery program, administered in pill form. Over time, she was embracing sobriety.

She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an professional – all common issues for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I was capable. I could be a mom.

On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, visited with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in awe of the little newborn 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 holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a decoration on her head, seated on the ground with the entryway at her back. She is slender. Her posture is humble so you cannot see her face. She is holding Izzie up on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and her companion looked at each other. “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 would become a mother.”

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Tools for treating drug-exposed newborns have been used for a long time.

The Finnegan NAS scale was established in 1975|