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In her eighth month of pregnancy and suffering, the expectant mother visited the ER after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and threw up.

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

She had used fentanyl before seeking medical help and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had several weeks to figure out how to get clean and give birth.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but medical staff detected 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 controlled doses of fentanyl every few hours, 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.

After five days, on 12 November 2022, Stephanie delivered a infant weighing 4lb 8oz – premature, little but surviving.

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

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

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she relapsed. She felt without value, blaming herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her dealer would not provide to her when she became obviously with child.

“However, I failed,” she said. “I needed help.”

The common assumption that her bond with her newborn would make her recover only led to increased guilt and negative self-talk, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.

The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was attached to tubes and leads, so tiny she thought she would harm her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.

Nurses and doctors told her about a care center, a innovative treatment home where women and their babies are supported as a unit, not apart.

In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when families are kept intact, recovery succeeds, custody cases decrease 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, two staff members came to collect her.

She stepped out of the hospital still in withdrawal, fearful and unsure about what would follow.

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At the care center, Stephanie still feared that CPS would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could arrive and take her baby away.

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

Survival outdoors, she said, was about survival. Substances came first; reliance came last.

Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to cause pain. She was unable to value herself, not to mention anyone else.

Each day, staff from Maddie’s Place transported her to a treatment center, provided orally. Gradually, she was beginning recovery.

She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an professional – all common issues for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I could parent.

On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to deliver baked goods. 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 showed no judgment,” 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 dressed in black pants and a hoodie, a beanie with a pompom on her head, seated on the ground with the door behind her. She is slender. Her face is downcast so you do not see her expression. She is holding Izzie up on her knee for the other kids to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The parents responded that the dads were busy, called away to other tasks, that they would be there if they could.

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

Stephanie and Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I found the courage. 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|