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Eight months pregnant and in severe pain, the expectant mother arrived at the ER after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she lived in a shed she had constructed in a friend’s yard. She was also dependent on fentanyl.

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

Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”

She had consumed opioids before coming to the ER and had only a brief window to get treated before she had to return to use once more. She thought she still had four weeks left to figure out how to get clean and give birth.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.

After five days, on the 12th of November, Stephanie had a baby girl weighing just over four pounds – premature, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been given a few hours prior to birth.

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

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she relapsed. She felt without value, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her source declined to supply to her when she became clearly expecting.

“However, I failed,” she said. “I required assistance.”

The common assumption that her bond with her newborn would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.

The baby was taken to the special care nursery. When Stephanie at last met her, she was hooked up to medical equipment, so little she thought she would harm her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

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

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

In numerous states, where a baby is identified with infant withdrawal condition frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like the care home is showing an important truth: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to collect her.

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

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At the facility, Stephanie still was concerned that CPS would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could arrive and remove her child.

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

Homelessness, she said, was about getting by. Substances came first; faith came last.

Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She did not know how to value herself, much less anyone else.

Daily, staff from Maddie’s Place transported her to a treatment center, given as medication. Gradually, she was starting to get clean.

She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an professional – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I could parent.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a recovery coach, stopped by with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is clad in black pants and a hoodie, a gray knit hat with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her knee for the children to see and they are gathered around, fawning and reaching out to the baby.

A young boy, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if possible.

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

Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I would become a mother.”

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Methods to address drug-exposed newborns have existed for decades.

The Finnegan NAS scale was established in 1975|