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In her eighth month of pregnancy and suffering, the expectant mother arrived at the hospital emergency room after an infection began spreading up her legs. Without a job or home, estranged from her family, she resided in a small structure she had assembled in a companion's property. She was also addicted to fentanyl.

As doctors treated her infection, she began to panic. The onset of withdrawal began. She slumped forward and became sick.

Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”

She had taken the drug before coming to the ER and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to figure out how to get clean and deliver her child.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.

Five days later, on the 12th of November, Stephanie delivered a daughter weighing 4lb 8oz – born before term, small but alive.

When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been provided a few hours prior to birth.

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

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An doctor 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 required assistance.”

The common assumption that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was attached to monitors, so tiny she thought she would break her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to give her child the name Izzie, after the attendant who showed compassion to her.

Hospital staff told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is found to have infant withdrawal condition frequently, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, outcomes improve, custody cases decrease and long-term costs decline.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to pick her up.

She departed the institution still in withdrawal, scared and uncertain about what would follow.

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At the facility, Stephanie still feared that child services would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could walk in and take her baby away.

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

Survival outdoors, she said, was about enduring. Drugs came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to hurt her. She lacked the ability to care for herself, let alone anyone else.

Each day, staff from the facility drove her to a treatment center, given as medication. Over time, she was beginning recovery.

She spent every minute 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 sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all frequent conditions for babies exposed to substances.

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

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. An advocate, a recovery coach, came over with her own children in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, sitting on the wooden floor with the exit nearby. She is thin. Her face is downcast so you do not see her expression. She is lifting the baby on her knee for the young ones to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the mothers: “Why are there no men?” 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 plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I would become a mother.”

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Approaches for managing babies with exposure have been available for years.

The Finnegan NAS scale was created in 1975|