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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the ER after her infection worsened up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had assembled in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed 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 take a hit.”

She had used fentanyl before seeking medical help and had only a brief window to get treated before she had to return to use once more. 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 not going anywhere.

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.

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 transitioned to methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.

Five days later, on the 12th of November, Stephanie delivered a baby girl weighing a small weight – early, tiny yet healthy.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her epidural had failed, her last dose of fentanyl had been given a few hours prior to birth.

She felt ill. Unprepared to be a mother. Not fit.

Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became clearly expecting.

“Yet I was unable,” she said. “I needed help.”

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

The infant was moved to the NICU. When Stephanie eventually visited her, she was attached to monitors, so tiny she thought she would hurt her. Holding her for the first time, she felt empty. “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 name her baby Izzie, 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 cared for jointly, not apart.

In numerous states, where a baby is found to have infant withdrawal condition frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like the care home is proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to pick her up.

She left the medical center still in recovery, anxious and doubtful about what would follow.

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At the facility, Stephanie still worried that CPS would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could enter and remove her child.

For the first two weeks, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Homelessness, she said, was about enduring. Drugs came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She did not know how to care for herself, much less anyone else.

Every day, staff from the center drove her to a treatment center, given as medication. Slowly, she was starting to get clean.

She devoted all her time when not in sessions 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 obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an specialist – all typical problems 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.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a mentor, visited with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She keeps a photo of the moment. She is clad in casual attire, a gray knit hat with a decoration on her head, seated on the ground with the door behind her. She is slender. Her posture is humble so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if possible.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and the specialist exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I would become a mother.”

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Approaches for managing drug-exposed newborns have been used for a long time.

The Finnegan NAS scale was created in 1975|