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Pregnant and experiencing intense discomfort, the expectant mother visited the medical facility after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she lived in a shed she had constructed in a acquaintance's garden. She was also addicted to fentanyl.

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

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had four weeks left to find a way to become sober and have this baby.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.

Five days later, on the 12th of November, Stephanie delivered a baby girl weighing just over four pounds – early, tiny yet healthy.

When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been administered shortly before she gave birth.

She felt unwell. Not ready for motherhood. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she failed. She felt without value, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her source declined to supply to her when she became clearly expecting.

“But I couldn’t,” she said. “I required assistance.”

The common assumption that her bond with her newborn would make her stop using only led to greater shame and self-abuse, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was attached to tubes and leads, so little she thought she would break her. Holding her for the first time, she felt detached. “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 Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about a specialized facility, a innovative treatment home where women and their babies are supported as a unit, not apart.

In numerous states, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place 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, a couple of employees came to collect her.

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

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At Maddie’s Place, Stephanie still worried that authorities would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could walk in and take her baby away.

For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about getting by. Addiction came first; reliance came last.

Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to hurt her. She was unable to love herself, much less anyone else.

Each day, staff from the center drove her to a treatment center, 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 daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an professional – all common issues for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own children in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She holds a picture of the moment. She is clad in casual attire, a gray knit hat with a decoration on her head, resting on the floor with the door behind her. She is thin. Her head is tilted forward so you cannot see her face. She is lifting the baby on her knee for the young ones to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the parents: “Where are all the dads?” The parents responded that the dads were busy, handling responsibilities, that they would be there if they could.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I would become a mother.”

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Methods to address infants affected by substances have existed for decades.

The assessment tool was established in 1975|