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Eight months pregnant and in severe pain, a woman named Stephanie visited the ER after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and became sick.

Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”

She had consumed opioids 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 four weeks left to plan her recovery and deliver her child.

The medical professional intervened. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, 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 abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

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 final administration of fentanyl had been given shortly before she gave birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she failed. She felt worthless, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her source would not provide to her when she became clearly expecting.

“However, I failed,” she said. “I required assistance.”

The widespread belief that her bond with her newborn would make her stop using only led to deeper self-loathing and negative self-talk, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.

The infant was moved to the NICU. When Stephanie eventually visited her, she was attached to tubes and leads, so tiny she thought she would hurt her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to name her baby after her caregiver, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In numerous states, where a baby is found to have newborn addiction symptoms regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like this facility is proving a simple point: when parents and infants remain united, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to pick her up.

She departed the institution still in withdrawal, scared and uncertain about what would come next.

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At the care center, Stephanie still feared that CPS would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could enter and take her baby away.

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

Homelessness, she said, was about enduring. Drugs came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She was unable to care for herself, let alone anyone else.

Every day, staff from the facility drove her to a clinic for methadone, administered in pill form. Gradually, she was beginning recovery.

She utilized each moment beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an specialist – all typical problems for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I could be a mom.

During a pre-holiday visit, 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 five kids in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She has an image of the moment. She is wearing black pants and a hoodie, a cap with a bobble on her head, resting on the floor with the door behind her. She is thin. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the young ones to see and they are standing close, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”

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Methods to address babies with exposure have been used for a long time.

The assessment tool was created in 1975|