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In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and vomited.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”

She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she had to return to relapse. She thought she still had several weeks to plan her recovery and have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.

A short time later, on the 12th of November, Stephanie gave birth to a infant weighing a small weight – born before term, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been given four hours before delivery.

She felt unwell. Not ready for motherhood. Not fit.

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she failed. She felt without value, blaming herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her source declined to supply to her when she became clearly expecting.

“Yet I was unable,” she said. “I had to seek support.”

The widespread belief that her affection for her child would make her recover only led to increased guilt and negative self-talk, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to monitors, so small she thought she would break her. Embracing her at last, she felt nothing. “I gazed upon 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 name her baby Izzie, after the attendant who showed compassion to her.

Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In numerous states, where a baby is found to have newborn addiction symptoms regularly, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a small, growing network of centers like the care home is showing an important truth: when families are kept intact, recovery succeeds, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.

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

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At Maddie’s Place, Stephanie still worried that CPS would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could walk in and take her baby away.

For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She was unable to love herself, let alone anyone else.

Daily, staff from the facility drove her to a treatment center, administered in pill form. Slowly, she was embracing sobriety.

She spent every minute 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 adverse reactions to milk and severe digestive problems. She needed dietary support. She also had sensory challenges and required an specialist – all frequent conditions for babies affected by withdrawal.

When a child recognizes these infants need affection, then I was capable. I could be a mom.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. An advocate, a peer support specialist, came over with her own family 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 were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She has an image of the moment. She is dressed in black pants and a hoodie, a cap with a bobble on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast so you cannot see her face. She is presenting her daughter on her lap for the other kids to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, handling responsibilities, that they would be there if they could.

“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could be a mom.”

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Methods to address babies with exposure have been used for a long time.

The Finnegan NAS scale was developed in 1975|