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In her eighth month of pregnancy and suffering, the expectant mother visited the medical facility after her infection worsened up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”

She had consumed opioids 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 four weeks left to figure out how to get clean and give birth.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the doctors would not let her go: 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 left, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.

A short time later, on a day in November 2022, Stephanie had a daughter weighing a small weight – early, tiny yet healthy.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been given a few hours prior to birth.

She felt unwell. Not ready for motherhood. Unworthy.

Stephanie had sought recovery multiple times while expecting, and felt awful each time she failed. She felt hopeless, criticizing herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her source declined to supply to her when she became obviously with child.

“But I couldn’t,” she said. “I needed help.”

The pervasive expectation that her love for her baby would make her recover only led to deeper self-loathing and negative self-talk, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a persistent condition.

The baby was taken to the NICU. When Stephanie at last met her, she was connected to monitors, so tiny she thought she would harm her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to call her daughter Izzie, after the professional who provided support to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is showing an important truth: when families are kept intact, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, care providers came to bring her to the facility.

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

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At the care center, Stephanie still worried that child services would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any point, someone could arrive and remove her child.

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

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

Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to cause pain. She was unable to care for herself, let alone anyone else.

Each day, staff from the facility took her to a clinic for methadone, given as medication. Over time, she was embracing sobriety.

She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an professional – all typical problems for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast so you cannot see her face. She is lifting the baby on her lap for the other kids to see and they are crowding near, admiring and touching to the baby.

Jacob, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there if they could.

“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could parent.”

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Approaches for managing babies with exposure have been available for years.

The Finnegan NAS scale was developed in 1975|