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In her eighth month of pregnancy and suffering, the expectant mother went to the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a companion's property. She was also hooked on fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She slumped forward and became sick.

Stephanie finally broke down. “I need to leave. 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 was compelled to leave to get high again. She thought she still had several weeks to plan her recovery and have this baby.

The nurse had other ideas. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

After five days, on 12 November 2022, Stephanie gave birth to a infant weighing just over four pounds – born before term, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been provided a few hours prior to birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had sought recovery multiple times while expecting, and felt terrible each time she failed. She felt hopeless, criticizing herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier declined to supply to her when she became visibly pregnant.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The baby was taken to the NICU. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would harm her. Holding her for the first time, 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 give her child the name after her caregiver, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a unique recovery environment where women and their babies are treated together, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition regularly, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when families are kept intact, results get better, foster placements fall and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to pick her up.

She left the medical center still in withdrawal, scared and uncertain about what would happen next.

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At Maddie’s Place, Stephanie still feared that authorities would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter and remove her child.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about enduring. Drugs 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 was unable to love herself, not to mention anyone else.

Daily, staff from the center drove her to a clinic for methadone, provided orally. Slowly, she was starting to get clean.

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 intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an specialist – all common issues for babies affected by withdrawal.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She holds a picture of the moment. She is dressed in black pants and a hoodie, a beanie with a pompom on her head, sitting on the wooden floor with the door behind her. She is thin. Her posture is humble so you cannot see her face. She is holding Izzie up on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.

One child, 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.

“When I have kids,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could be a mom.”

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Approaches for managing babies with exposure have been used for a long time.

The assessment tool was developed in 1975|