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Pregnant and experiencing intense discomfort, a woman named Stephanie went to the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had assembled in a companion's property. She was also hooked on fentanyl.

As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and vomited.

Stephanie finally broke down. “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 just enough time to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to plan her recovery and deliver her child.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“Yes, I am,” 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 face grave danger.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in addiction recovery.

Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing a small weight – premature, little but surviving.

When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been administered a few hours prior to birth.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she relapsed. She felt hopeless, berating herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

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

The common assumption that her love for her baby would make her quit only led to greater shame and self-abuse, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The baby was taken to the NICU. When Stephanie at last met her, she was attached to monitors, so little she thought she would harm her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to call her daughter Izzie, after the attendant who showed compassion to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, results get better, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She stepped out of the hospital still in withdrawal, fearful and unsure about what would follow.

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At Maddie’s Place, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any point, someone could walk in and remove her child.

For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about enduring. Addiction came first; faith came last.

Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to let her down. She lacked the ability to care for herself, not to mention anyone else.

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

She devoted all her time outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies born with NAS.

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 individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a mentor, stopped by with her own five kids 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 wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She has an image of the moment. She is clad in casual attire, a beanie with a bobble on her head, resting on the floor with the entryway at her back. She is slender. Her posture is humble so you cannot see her face. She is lifting the baby on her leg for the children to see and they are crowding near, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could parent.”

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

The Finnegan NAS scale was developed in 1975|