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Pregnant and experiencing intense discomfort, a woman named Stephanie went to the medical facility after her infection worsened up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and threw up.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had used fentanyl before seeking medical help and had only a brief window to get treated before she had to return to get high again. She thought she still had several weeks to find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.

Five days later, on a day in November 2022, Stephanie had a daughter weighing a small weight – premature, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her pain relief did not work, her final administration of fentanyl had been provided a few hours prior to birth.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she failed. She felt worthless, criticizing herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her dealer would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her quit only led to deeper self-loathing and self-harm, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to monitors, so little she thought she would hurt her. Cradling her initially, she felt empty. “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 give her child the name Izzie, after the professional who provided support to her.

Medical personnel told her about a care center, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, results get better, custody cases decrease and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

She left the medical center still in recovery, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still feared that CPS would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and separate them.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about survival. Addiction came first; reliance came last.

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to love herself, not to mention anyone else.

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

She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an occupational therapist – 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 parent.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. A support specialist, a recovery coach, came over with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the little newborn 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 wearing casual attire, a gray knit hat with a bobble on her head, sitting on the wooden floor with the door behind her. She is thin. Her posture is humble so you do not see her expression. She is holding Izzie up on her lap for the other kids to see and they are standing close, fawning and reaching out to the baby.

A young boy, eight, asked the mothers: “Why are there no men?” The parents responded that the men were occupied, called away to other tasks, that they would be there if possible.

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”

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

The Finnegan NAS scale was developed in 1975|