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Eight months pregnant and in severe pain, a woman named Stephanie arrived at the ER after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and vomited.

Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had several weeks to figure out how to get clean and deliver her child.

The nurse had other ideas. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.

Five days later, on a day in November 2022, Stephanie had a infant weighing a small weight – early, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been administered a few hours prior to birth.

She felt sick. Ill-equipped for parenting. Undeserving.

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she relapsed. She felt worthless, berating herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her source declined to supply to her when she became visibly pregnant.

“But I couldn’t,” she said. “I had to seek support.”

The pervasive expectation that her love for her baby would make her recover only led to greater shame and negative self-talk, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.

The newborn was transferred to the NICU. When Stephanie finally saw her her, she was attached to tubes and leads, so tiny she thought she would hurt her. Embracing her at last, she felt empty. “I looked at 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 call her daughter Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like the care home is proving a simple point: when parents and infants remain united, outcomes improve, foster placements fall and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to collect her.

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

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At the care center, Stephanie still worried that CPS would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could arrive and separate them.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about getting by. Substances came first; faith came last.

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to let her down. She did not know how to care for herself, much less anyone else.

Every day, staff from the facility transported her to a clinic for methadone, administered in pill form. Gradually, she was embracing sobriety.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing black pants and a hoodie, a beanie with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her head is tilted forward so you do not see her expression. She is lifting the baby on her knee for the children to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there given the chance.

“In the future,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I would become a mother.”

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Tools for treating babies with exposure have been used for a long time.

The evaluation method was created in 1975|