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Pregnant and experiencing intense discomfort, the expectant mother arrived at the ER after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and vomited.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”

She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to plan her recovery and deliver her child.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.

Five days later, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – early, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she failed. She felt worthless, criticizing 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 clearly expecting.

“Yet I was unable,” she said. “I required assistance.”

The pervasive expectation that her bond with her newborn would make her quit only led to deeper self-loathing and self-abuse, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was hooked up to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to give her child the name the same as her nurse, after the professional who provided support to her.

Hospital staff told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with infant withdrawal condition regularly, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is showing an important truth: when families are kept intact, recovery succeeds, custody cases decrease and future expenses reduce.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to pick her up.

She stepped out of the hospital still in withdrawal, fearful and unsure about what would happen next.

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At Maddie’s Place, Stephanie still was concerned that authorities would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and remove her child.

For the beginning period, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to let her down. She did not know how to value herself, not to mention anyone else.

Each day, staff from the facility took her to a treatment center, provided orally. Slowly, she was beginning recovery.

She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.

One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. An advocate, a mentor, came over with her own family in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the little newborn 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 pompom on her head, seated on the ground with the door behind her. She is lean. Her head is tilted forward so you miss her features. She is presenting her daughter on her lap for the children to see and they are standing close, showing interest to the baby.

One child, eight, asked the moms: “What about the fathers?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there if they could.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could parent.”

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Tools for treating babies with exposure have been used for a long time.

The assessment tool was developed in 1975|