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Pregnant and experiencing intense discomfort, the expectant mother went to the ER after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and threw up.

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

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and have this baby.

The medical professional intervened. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was critical, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

Five days later, on the 12th of November, Stephanie gave birth to a baby girl weighing a small weight – born before term, small but alive.

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

She felt unwell. Unprepared to be a mother. Unworthy.

Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she relapsed. She felt without value, berating herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her supplier declined to supply to her when she became clearly expecting.

“Yet I was unable,” she said. “I needed help.”

The common assumption that her affection for her child would make her recover only led to greater shame and negative self-talk, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was attached to tubes and leads, so little she thought she would harm her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to name her baby after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about a care center, a unique recovery environment where women and their babies are cared for jointly, not apart.

In numerous states, where a baby is found to have 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 small, growing network of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, outcomes improve, custody cases decrease and long-term costs decline.

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

She stepped out of the hospital still in detox, fearful and unsure about what would happen next.

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At the facility, Stephanie still feared that authorities would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could walk in and separate them.

For the first two weeks, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

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

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to let her down. She lacked the ability to value herself, much less anyone else.

Every day, staff from Maddie’s Place drove her to a recovery program, provided orally. Over time, she was beginning recovery.

She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an professional – all frequent conditions for babies affected by withdrawal.

When a child recognizes these infants need affection, then I could do this. I could be a mom.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. An advocate, a mentor, visited with her own family in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in wonder 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 holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a pompom on her head, seated on the ground with the entryway at her back. She is thin. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her leg for the young ones to see and they are crowding near, showing interest to the baby.

One child, eight, asked the moms: “What about the fathers?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if they could.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I would become a mother.”

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

The evaluation method was created in 1975|