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Pregnant and experiencing intense discomfort, the expectant mother went to the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had constructed in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before coming to the ER and had just enough time to get treated before she had to return to get high again. She thought she still had four weeks left to plan her recovery and give birth.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the leg infection was serious, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.

Five days later, on the 12th of November, Stephanie gave birth to a baby girl weighing a small weight – premature, small but alive.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been given shortly before she gave 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 failed. She felt worthless, berating herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became visibly pregnant.

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

The pervasive expectation that her love for her baby would make her recover only led to greater shame and self-abuse, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.

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

After two days she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is proving a simple point: when mothers and babies stay together, outcomes improve, foster placements fall and overall savings increase.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

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

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At Maddie’s Place, Stephanie still worried that authorities would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could arrive and remove her child.

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

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

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to love herself, not to mention anyone else.

Every day, staff from Maddie’s Place drove her to a clinic for methadone, given as medication. Gradually, she was embracing sobriety.

She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an professional – all typical problems for babies exposed to substances.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. A support specialist, a recovery coach, visited with her own children in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She keeps a photo of the moment. She is dressed in casual attire, a beanie with a bobble on her head, sitting on the wooden floor with the door behind her. She is lean. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her leg for the other kids to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if possible.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I would become a mother.”

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Methods to address drug-exposed newborns have been used for a long time.

The evaluation method was created in 1975|