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Eight months pregnant and in severe pain, the expectant mother visited the ER after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had assembled in a acquaintance's garden. She was also dependent on fentanyl.

As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie ultimately gave in. “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 give birth.

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

“I will go,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.

She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

After five days, on the 12th of November, Stephanie had a infant weighing just over four pounds – premature, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had sought recovery repeatedly before birth, and felt awful each time she relapsed. She felt hopeless, berating herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier declined to supply to her when she became obviously with child.

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

The widespread belief that her affection for her child would make her quit only led to deeper self-loathing and self-harm, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was hooked up to medical equipment, so tiny she thought she would break her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to call her daughter Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to bring her to the facility.

She left the medical center still in detox, scared and uncertain about what would follow.

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At Maddie’s Place, Stephanie still feared that authorities would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could arrive and remove her child.

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

Survival outdoors, she said, was about survival. Drugs came first; faith came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to cause pain. She was unable to value herself, not to mention anyone else.

Daily, staff from the facility took her to a clinic for methadone, administered in pill form. Over time, she was starting to get clean.

She devoted all her time beyond therapy 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 obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all common issues for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The young ones stared in wonder of the tiny infant 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 keeps a photo of the moment. She is clad in casual attire, a cap with a bobble on her head, sitting on the wooden floor with the door behind her. She is slender. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there given the chance.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I would become a mother.”

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Methods to address drug-exposed newborns have been available for years.

The evaluation method was created in 1975|