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Eight months pregnant and in severe pain, the expectant mother visited the ER after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had built in a friend’s yard. She was also dependent on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and threw up.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she was compelled to leave to relapse. She thought she still had several weeks to find a way to become sober and give birth.

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

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.

Five days later, on 12 November 2022, Stephanie had a baby girl weighing a small weight – premature, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her epidural had failed, her last dose of fentanyl had been given a few hours prior to birth.

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

Stephanie had sought recovery multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her supplier declined to supply to her when she became visibly pregnant.

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

The pervasive expectation that her love for her baby would make her stop using only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to monitors, so little she thought she would harm her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to give her child the name after her caregiver, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where women and their babies are cared for jointly, not apart.

In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is showing an important truth: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to collect her.

She left the medical center still in withdrawal, fearful and unsure about what would follow.

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At the care center, Stephanie still was concerned that child services would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and remove her child.

For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”

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

Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She did not know how to love herself, not to mention anyone else.

Each day, staff from the facility drove her to a clinic for methadone, administered in pill form. Slowly, she was embracing sobriety.

She utilized each moment when not in sessions 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 pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an professional – all typical problems for babies affected by withdrawal.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. A support specialist, a recovery coach, visited with her own children in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in casual attire, a cap with a decoration on her head, seated on the ground with the entryway at her back. She is thin. Her head is tilted forward so you miss her features. She is lifting the baby on her leg for the other kids to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there if they could.

“Once I become a parent,” 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 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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Tools for treating infants affected by substances have been available for years.

The Finnegan NAS scale was created in 1975|