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Eight months pregnant and in severe pain, a woman named Stephanie visited the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also dependent on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and threw up.

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

She had taken the drug before arriving at the hospital and had just enough time to get treated before she needed to go home to use once more. She thought she still had a month remaining to plan her recovery and have this baby.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I will go,” 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.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

After five days, on the 12th of November, Stephanie delivered a infant weighing just over four pounds – early, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her final administration of fentanyl had been given four hours before delivery.

She felt unwell. Ill-equipped for parenting. Unworthy.

Stephanie had tried to get clean several times during pregnancy, and felt awful each time she relapsed. She felt worthless, criticizing herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her source would not provide to her when she became visibly pregnant.

“But I couldn’t,” she said. “I needed help.”

The widespread belief that her love for her baby would make her quit only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.

The infant was moved to the special care nursery. When Stephanie eventually visited her, she was attached to monitors, so little she thought she would hurt her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

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

Nurses and doctors told her about a care center, a unique recovery environment where women and their babies are cared for jointly, not apart.

In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to collect her.

She departed the institution still in detox, anxious and doubtful about what would come next.

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At Maddie’s Place, Stephanie still worried that CPS would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could arrive and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about survival. Substances came first; trust came last.

Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to hurt her. She did not know how to value herself, let alone anyone else.

Every day, staff from the center transported her to a clinic for methadone, provided orally. Slowly, she was starting to get clean.

She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an specialist – all common issues for babies affected by withdrawal.

When a child recognizes these infants need affection, then I could do this. I could parent.

During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. A support specialist, a recovery coach, stopped by with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She holds a picture of the moment. She is dressed in casual attire, a cap with a bobble on her head, sitting on the wooden floor with the exit nearby. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her lap for the children to see and they are gathered around, admiring and touching to the baby.

A young boy, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if they could.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I was able. I would become a mother.”

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Tools for treating drug-exposed newborns have existed for decades.

The assessment tool was created in 1975|