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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. Jobless and without shelter, cut off from her relatives, she lived in a shed she had built in a companion's property. She was also dependent on fentanyl.

As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and became sick.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had several weeks to find a way to become sober and give birth.

The medical professional intervened. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

Five days later, on a day in November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – premature, little but surviving.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been given four hours before delivery.

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

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she relapsed. She felt hopeless, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her supplier declined to supply to her when she became visibly pregnant.

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

The common assumption that her bond with her newborn would make her stop using only led to deeper self-loathing and self-harm, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was hooked up to monitors, so tiny she thought she would harm her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to call her daughter Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about a specialized facility, 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 found to have newborn addiction symptoms frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like the care home is proving a simple point: when families are kept intact, results get better, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to pick her up.

She left the medical center still in withdrawal, scared and uncertain about what would happen next.

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At Maddie’s Place, Stephanie still feared that authorities would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could arrive and take her baby away.

For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She lacked the ability to value herself, let alone anyone else.

Each day, staff from the facility transported 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 getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an specialist – all frequent conditions for babies affected by withdrawal.

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

One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, 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 admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. She is lean. Her posture is humble so you miss her features. She is presenting her daughter on her knee for the young ones to see and they are gathered around, showing interest to the baby.

One child, eight, asked the mothers: “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 if they could.

“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could parent.”

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Approaches for managing babies with exposure have existed for decades.

The assessment tool was created in 1975|