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Eight months pregnant and in severe pain, the expectant mother went to the ER after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and became sick.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had used fentanyl 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 find a way to become sober and deliver her child.

The attending nurse disagreed. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was severe, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

After five days, on the 12th of November, Stephanie delivered a infant weighing a small weight – early, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given shortly before she gave birth.

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

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, blaming herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her supplier declined to supply to her when she became obviously with child.

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

The common assumption that her love for her baby would make her quit only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the NICU. When Stephanie at last met her, she was hooked up to medical equipment, so little she thought she would break her. Cradling her initially, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.

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

In many parts of America, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is showing an important truth: when families are kept intact, recovery succeeds, foster placements fall and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, two staff members came to collect her.

She left the medical center still in detox, scared and uncertain about what would follow.

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At the care center, Stephanie still feared that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could enter and remove her child.

For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about enduring. Drugs came first; reliance came last.

Stephanie had one close friend, but even that relationship was delicate. The people she loved always found ways to hurt her. She did not know how to love herself, much less anyone else.

Each day, staff from Maddie’s Place drove her to a treatment center, provided orally. Slowly, she was embracing sobriety.

She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had sensory challenges and required an specialist – all frequent conditions for babies born with NAS.

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 those still using can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own family in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She keeps a photo of the moment. She is clad in casual attire, a beanie with a decoration on her head, sitting on the wooden floor with the door behind her. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are crowding near, fawning and reaching out to the baby.

A young boy, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could be a mom.”

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Approaches for managing drug-exposed newborns have been used for a long time.

The evaluation method was developed in 1975|