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Eight months pregnant and in severe pain, the expectant mother visited the medical facility after an infection began spreading up her legs. Without a job or home, separated from loved ones, she lived in a shed she had assembled in a companion's property. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and became sick.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had several weeks to find a way to become sober and give birth.

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

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

After five days, on a day in November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – early, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been provided four hours before delivery.

She felt ill. Unprepared to be a mother. Undeserving.

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her source declined to supply to her when she became clearly expecting.

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

The widespread belief that her affection for her child would make her stop using only led to greater shame and self-harm, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The newborn was transferred to the NICU. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would break her. Embracing her at last, she felt detached. “I looked 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 Izzie, after the attendant who showed compassion to her.

Hospital staff told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a small, growing network of centers like this facility is proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to collect her.

She departed the institution still in detox, fearful and unsure about what would follow.

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At Maddie’s Place, Stephanie still feared that child services would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could walk in and remove her child.

For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about getting by. Substances came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to hurt her. She lacked the ability to value herself, not to mention anyone else.

Each day, staff from Maddie’s Place drove her to a clinic for methadone, administered in pill form. Gradually, she was starting to get clean.

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 sensory challenges and required an occupational therapist – all common issues for babies exposed to substances.

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

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. An advocate, a mentor, visited with her own children in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, resting on the floor with the exit nearby. She is slender. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her leg for the children to see and they are standing close, showing interest to the baby.

One child, eight, asked the mothers: “Where are all the dads?” The parents responded that the dads were busy, handling responsibilities, that they would be there given the chance.

“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I would become a mother.”

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Methods to address infants affected by substances have been used for a long time.

The assessment tool was created in 1975|