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Eight months pregnant and in severe pain, a woman named Stephanie arrived at the ER after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also hooked on fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She slumped forward and vomited.

Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”

She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she needed to go home to get high again. She thought she still had several weeks to figure out how to get clean and give birth.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was critical, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing just over four pounds – early, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been administered a few hours prior to birth.

She felt sick. Unprepared to be a mother. Unworthy.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she relapsed. She felt hopeless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her dealer declined to supply to her when she became visibly pregnant.

“But I couldn’t,” she said. “I had to seek support.”

The common assumption that her bond with her newborn would make her stop using only led to greater shame and self-abuse, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.

The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would break her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

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

Hospital staff told her about Maddie’s Place, a new kind of care center where women and their babies are supported as a unit, not apart.

In much of the US, where a baby is found to have newborn addiction symptoms regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when parents and infants remain united, results get better, custody cases decrease and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, care providers came to collect her.

She stepped out of the hospital still in withdrawal, anxious and doubtful about what would come next.

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At Maddie’s Place, Stephanie still worried that child services would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could enter and remove her child.

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

Homelessness, she said, was about survival. Drugs came first; reliance came last.

Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to hurt her. She lacked the ability to care for herself, much less anyone else.

Each day, staff from Maddie’s Place transported her to a recovery program, given as medication. Gradually, she was beginning recovery.

She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an occupational therapist – all typical problems for babies exposed to substances.

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

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a recovery coach, visited with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a cap with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her lap for the children to see and they are crowding near, showing interest to the baby.

A young boy, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could parent.”

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Tools for treating infants affected by substances have existed for decades.

The assessment tool was established in 1975|