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Pregnant and experiencing intense discomfort, a woman named Stephanie visited the ER after her infection worsened up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and became sick.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she had to return to relapse. She thought she still had a month remaining to find a way to become sober and give birth.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

A short time later, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – early, tiny yet healthy.

When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been administered a few hours prior to birth.

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

Stephanie had tried to get clean 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 obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became obviously with child.

“However, I failed,” she said. “I required assistance.”

The common assumption that her love for her baby would make her stop using only led to increased guilt and self-abuse, a impetus 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 special care nursery. When Stephanie eventually visited her, she was hooked up to medical equipment, so little she thought she would break her. Embracing her at last, 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 give her child the name after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a developing system of centers like the care home is demonstrating a key fact: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to collect her.

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

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At Maddie’s Place, Stephanie still worried that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could enter and remove her child.

For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about enduring. Addiction came first; reliance came last.

Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to let her down. She lacked the ability to love herself, let alone anyone else.

Daily, staff from the facility took her to a treatment center, given as medication. Over time, she was starting to get clean.

She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and severe digestive problems. She needed nutritional guidance. She also had sensory challenges 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.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. An advocate, a mentor, stopped by with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a bobble on her head, sitting on the wooden floor with the exit nearby. She is slender. Her posture is humble so you miss her features. She is presenting her daughter on her knee for the children to see and they are crowding near, fawning and reaching out to the baby.

Jacob, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could parent.”

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

The evaluation method was created in 1975|