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In her eighth month of pregnancy and suffering, the expectant mother arrived at the hospital emergency room after an infection began spreading up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also dependent on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and became sick.

Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”

She had taken the drug before arriving at the hospital and had just enough time to get treated before she needed to go home to use once more. She thought she still had four weeks left to figure out how to get clean and have this baby.

The medical professional intervened. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was serious, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.

Five days later, on a day in November 2022, Stephanie had a infant weighing a small weight – early, little but surviving.

When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been given four hours before delivery.

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

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she relapsed. She felt hopeless, berating herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her dealer 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 stop using only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was hooked up to medical equipment, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to name her baby the same as her nurse, after the professional who provided support to her.

Hospital staff told her about a care center, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is identified with newborn addiction symptoms regularly, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when mothers and babies stay together, recovery succeeds, foster placements fall and long-term costs decline.

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, fearful and unsure about what would follow.

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At Maddie’s Place, Stephanie still worried that authorities would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could enter and take her baby away.

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.”

Life on the streets, she said, was about enduring. Drugs came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to hurt her. She lacked the ability to love herself, let alone anyone else.

Every day, staff from Maddie’s Place transported her to a clinic for methadone, given as medication. Over time, she was embracing sobriety.

She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I could be a mom.

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. An advocate, a peer support specialist, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They were innocent,” 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 clad in black pants and a hoodie, a gray knit hat with a decoration on her head, seated on the ground with the door behind her. She is lean. Her head is tilted forward so you miss her features. She is lifting the baby on her lap for the children to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there given the chance.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could parent.”

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Methods to address babies with exposure have been available for years.

The assessment tool was established in 1975|