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Eight months pregnant and in severe pain, the expectant mother arrived at the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had built in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and became sick.

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 sufficient opportunity to get treated before she had to return to get high again. She thought she still had several weeks to plan her recovery and deliver her child.

The nurse had other ideas. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

She encouraged 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 medication that eases withdrawal and is often prescribed in rehabilitation.

Five days later, on a day in November 2022, Stephanie had a infant weighing a small weight – early, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been given four hours before delivery.

She felt unwell. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her dealer refused to sell 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 quit only led to deeper self-loathing and self-harm, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.

The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so little she thought she would break her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter the same as her nurse, after the nurse who had been so kind to her.

Nurses and doctors told her about Maddie’s Place, 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 neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when mothers and babies stay together, results get better, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to collect her.

She departed the institution still in detox, fearful and unsure about what would happen next.

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At Maddie’s Place, Stephanie still worried that CPS would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could arrive and remove her child.

For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about getting by. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to cause pain. She did not know how to care for herself, let alone anyone else.

Daily, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Gradually, she was beginning recovery.

She utilized each moment when not in sessions 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 severe digestive problems. She needed dietary support. She also had sensory challenges and required an occupational therapist – all typical problems for babies affected by withdrawal.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a peer support specialist, came over with her own children in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She holds a picture of the moment. She is clad in black pants and a hoodie, a beanie with a pompom on her head, resting on the floor with the door behind her. She is slender. Her face is downcast so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are gathered around, showing interest to the baby.

One child, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if possible.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.”

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Approaches for managing infants affected by substances have been available for years.

The evaluation method was developed in 1975|