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Pregnant and experiencing intense discomfort, the expectant mother visited the ER after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had constructed in a acquaintance's garden. She was also dependent on fentanyl.

As physicians addressed her infection, she began to panic. Withdrawal was setting in. She slumped forward and threw up.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to find a way to become sober and give birth.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – early, little but surviving.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was detached. Her epidural had failed, her previous intake of fentanyl had been provided a few hours prior to birth.

She felt ill. Ill-equipped for parenting. Not fit.

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she relapsed. She felt without value, criticizing herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her dealer declined to supply to her when she became visibly pregnant.

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

The pervasive expectation that her love for her baby would make her recover only led to greater shame and self-harm, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to medical equipment, so little she thought she would hurt her. Cradling her initially, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to name her baby Izzie, after the professional who provided support to her.

Nurses and doctors told her about a specialized facility, a new kind of care center where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is found to have newborn addiction symptoms regularly, infants are still rushed to special care and medicated while their mothers face parental assessments. But a small, growing network of centers like this facility is showing an important truth: when parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to collect her.

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

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At the facility, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any time, someone could enter and remove her child.

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 survival. Drugs came first; trust came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to love herself, much less anyone else.

Every day, staff from Maddie’s Place drove her to a clinic for methadone, administered in pill form. Slowly, she was beginning recovery.

She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues 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.

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing black pants and a hoodie, a cap with a bobble on her head, resting on the floor with the door behind her. She is slender. Her face is downcast so you cannot see her face. She is holding Izzie up on her knee for the young ones to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the mothers: “Where are all the dads?” The parents responded that the dads were busy, called away to other tasks, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I would become a mother.”

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Approaches for managing infants affected by substances have existed for decades.

The assessment tool was established in 1975|