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Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the medical facility after an infection began spreading up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and vomited.

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

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had a month remaining 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 medical facility declined to release her: the leg infection was critical, but doctors had discovered she also had an leakage of amniotic fluid. 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 periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.

A short time later, on a day in November 2022, Stephanie had a daughter weighing a small weight – early, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her epidural had failed, her previous intake of fentanyl had been given shortly before she gave birth.

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

Stephanie had sought recovery multiple times while expecting, and felt awful each time she was unsuccessful. She felt worthless, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her source would not provide to her when she became obviously with child.

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

The common assumption that her affection for her child would make her stop using only led to increased guilt 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 persistent condition.

The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was attached to monitors, so tiny she thought she would break her. Embracing her at last, she felt nothing. “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 nurse who had been so kind to her.

Medical personnel told her about a care center, a innovative treatment home where women and their babies are treated together, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She departed the institution still in recovery, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still feared that authorities would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could arrive and remove her child.

For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about enduring. Substances came first; reliance came last.

Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to let her down. She lacked the ability to care for herself, much less anyone else.

Daily, staff from the facility transported her to a treatment center, provided orally. Over time, 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 infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an professional – all typical problems for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, 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 young ones stared in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, sitting on the wooden floor with the exit nearby. She is lean. Her face is downcast so you cannot see her face. She is lifting the baby on her lap for the young ones to see and they are crowding near, showing interest to the baby.

A young boy, eight, asked the parents: “Why are there no men?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there if possible.

“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I would become a mother.”

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Methods to address drug-exposed newborns have existed for decades.

The Finnegan NAS scale was created in 1975|