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In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the hospital emergency room after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also addicted to fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and threw up.

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had just enough time to get treated before she had to return to use once more. 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 going anywhere.

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – early, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been administered shortly before she gave birth.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she failed. She felt worthless, blaming herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her supplier refused to sell to her when she became obviously with child.

“However, I failed,” she said. “I needed help.”

The pervasive expectation that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the NICU. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

After two days she decided to call her daughter after her caregiver, after the professional who provided support to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is proving a simple point: when families are kept intact, results get better, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.

She departed the institution still in detox, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still was concerned that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and take her baby away.

For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”

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

Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She was unable to value herself, not to mention anyone else.

Each day, staff from Maddie’s Place drove her to a treatment center, given as medication. Over time, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an professional – all common issues for babies affected by withdrawal.

When a child recognizes these infants need affection, then I was capable. I could parent.

During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own children in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, resting on the floor with the entryway at her back. She is slender. Her face is downcast so you miss her features. She is lifting the baby on her leg for the other kids to see and they are crowding near, fawning and reaching out to the baby.

A young boy, eight, asked the mothers: “Why are there no men?” 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 her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could be a mom.”

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

The Finnegan NAS scale was created in 1975|