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Eight months pregnant and in severe pain, the expectant mother went to the medical facility 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 assembled in a friend’s yard. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and vomited.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had a month remaining to figure out how to get clean and deliver her child.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but medical staff detected 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.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.

A short time later, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – born before term, small but alive.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been given a few hours prior to birth.

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

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she failed. She felt without value, berating herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her supplier refused to sell to her when she became clearly expecting.

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

The widespread belief that her affection for her child would make her recover only led to greater shame and self-harm, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was hooked up to monitors, so little she thought she would break her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to call her daughter Izzie, after the attendant who showed compassion to her.

Medical personnel told her about Maddie’s Place, a new kind of care center where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, results get better, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, care providers came to bring her to the facility.

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

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At the care center, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could walk in and remove her child.

For the initial fortnight, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about getting by. Substances came first; reliance came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She lacked the ability to care for herself, let alone anyone else.

Each day, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Slowly, she was starting to get clean.

She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges 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 could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own family in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She has an image of the moment. She is wearing dark trousers and a sweatshirt, a cap with a bobble on her head, sitting on the wooden floor with the door behind her. She is thin. Her face is downcast so you do not see her expression. She is presenting her daughter on her lap for the young ones to see and they are standing close, admiring and touching to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I was able. I would become a mother.”

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Methods to address drug-exposed newborns have been available for years.

The assessment tool was created in 1975|