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In her eighth month of pregnancy and suffering, a woman named Stephanie went to the ER after her infection worsened up her legs. Without a job or home, separated from loved ones, she lived in a shed she had constructed in a acquaintance's garden. She was also dependent on fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

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

She had used fentanyl before seeking medical help and had just enough time to get treated before she needed to go home to relapse. She thought she still had several weeks to find a way to become sober and deliver her child.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.

Five days later, on a day in November 2022, Stephanie delivered a daughter weighing 4lb 8oz – early, small but alive.

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

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

Stephanie had sought recovery several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her source declined to supply to her when she became visibly pregnant.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her affection for her child would make her stop using only led to greater shame and self-abuse, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so small she thought she would harm her. Embracing her at last, she felt empty. “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 after her caregiver, after the attendant who showed compassion to her.

Nurses and doctors told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In much of the US, where a baby is found to have infant withdrawal condition every 18 minutes, 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 Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to pick her up.

She stepped out of the hospital still in detox, fearful and unsure about what would come next.

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At the care center, Stephanie still worried that CPS would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could enter and remove her child.

For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about survival. Addiction came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to cause pain. She lacked the ability to care for herself, not to mention anyone else.

Each day, staff from the facility drove her to a clinic for methadone, provided orally. Slowly, she was beginning recovery.

She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies exposed to substances.

Seeing that even a young person understands the need for care, then I was capable. I could be a mom.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own family in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in awe 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 has an image of the moment. She is wearing casual attire, a cap with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her posture is humble so you do not see her expression. She is presenting her daughter on her knee for the young ones to see and they are standing close, fawning and reaching out to the baby.

One child, eight, asked the mothers: “What about the fathers?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion looked at each other. “I just lost it and fell apart,” 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 babies with exposure have been used for a long time.

The assessment tool was established in 1975|