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Pregnant and experiencing intense discomfort, the expectant mother went to the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she began to panic. Withdrawal was setting in. She slumped forward and vomited.

Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”

She had taken the drug before arriving at the hospital and had only a brief window to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and give birth.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

After five days, on a day in November 2022, Stephanie delivered a daughter weighing a small weight – premature, little but surviving.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been given four hours before delivery.

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

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she failed. She felt hopeless, criticizing 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.

“Yet I was unable,” she said. “I required assistance.”

The pervasive expectation that her bond with her newborn would make her quit only led to increased guilt and negative self-talk, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to monitors, so small she thought she would harm her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In much of the US, where a baby is diagnosed with infant withdrawal condition frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, outcomes improve, foster placements fall and overall savings increase.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to collect her.

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

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At the facility, 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 enter and remove her child.

For the initial fortnight, 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.”

Life on the streets, she said, was about survival. Addiction came first; trust came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She did not know how to value herself, not to mention anyone else.

Each day, staff from the facility transported her to a clinic for methadone, provided orally. Over time, she was beginning recovery.

She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an professional – all typical problems for babies born with NAS.

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 was in the common room, where those still using can come for supervised visits with their babies. An advocate, a recovery coach, visited with her own five kids 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 admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She keeps a photo of the moment. She is dressed in casual attire, 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 do not see her expression. She is holding Izzie up on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the moms: “Why are there no men?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if possible.

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

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could parent.”

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Approaches for managing drug-exposed newborns have been available for years.

The Finnegan NAS scale was developed in 1975|