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Pregnant and experiencing intense discomfort, a woman named Stephanie visited the medical facility after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had assembled in a companion's property. She was also dependent on fentanyl.

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

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”

She had taken the drug before coming to the ER and had only a brief window to get treated before she had to return to relapse. She thought she still had a month remaining to figure out how to get clean and give birth.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

After five days, on a day in November 2022, Stephanie delivered a baby girl weighing just over four pounds – born before term, little but surviving.

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

She felt sick. Ill-equipped for parenting. Unworthy.

Stephanie had sought recovery several times during pregnancy, and felt terrible each time she relapsed. She felt worthless, blaming herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her supplier declined to supply to her when she became clearly expecting.

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

The pervasive expectation that her love for her baby would make her recover only led to deeper self-loathing and self-abuse, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to medical equipment, so little she thought she would break her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.

Hospital staff told her about Maddie’s Place, a innovative treatment home where women and their babies are treated together, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care 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, recovery succeeds, fewer children enter care and long-term costs decline.

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

She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.

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

For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to hurt her. She lacked the ability to value herself, not to mention anyone else.

Daily, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Gradually, she was beginning recovery.

She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. An advocate, a recovery coach, came over with her own children in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She holds a picture of the moment. She is dressed in casual attire, a beanie with a bobble on her head, resting on the floor with the entryway at her back. She is lean. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her lap for the children to see and they are crowding near, admiring and touching to the baby.

A young boy, eight, asked the parents: “Why are there no men?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I could parent.”

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Tools for treating drug-exposed newborns have existed for decades.

The evaluation method was created in 1975|