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Eight months pregnant and in severe pain, the expectant mother visited the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and vomited.

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had consumed opioids before coming to the ER and had just enough time to get treated before she needed to go home to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.

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

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “simply” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

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

The widespread belief that her bond with her newborn would make her quit only led to greater shame and self-harm, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was connected to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain 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.

Hospital staff told her about a specialized facility, a innovative treatment home where women and their babies are treated together, not apart.

In much of the US, where a baby is found to have infant withdrawal condition regularly, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, results get better, custody cases decrease and long-term costs decline.

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

She left the medical center still in detox, anxious and doubtful about what would happen next.

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At Maddie’s Place, Stephanie still was concerned that authorities would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could walk in and separate them.

For the initial fortnight, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She lacked the ability to value herself, not to mention anyone else.

Daily, staff from Maddie’s Place drove her to a clinic for methadone, provided orally. Gradually, she was embracing sobriety.

She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an professional – all frequent conditions for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I could be a mom.

One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own family in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in wonder of the small baby 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 keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, seated on the ground with the door behind her. She is lean. Her face is downcast so you cannot see her face. She is holding Izzie up on her knee for the children to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the parents: “Why are there no men?” 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’m going to be the best dad ever. I will teach them about love.”

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I would become a mother.”

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Tools for treating babies with exposure have been available for years.

The Finnegan NAS scale was developed in 1975|