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Pregnant and experiencing intense discomfort, the expectant mother arrived at the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had built in a companion's property. She was also dependent on fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”

She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home to get high again. 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 allowed to leave.

“I am leaving,” Stephanie said.

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

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.

A short time later, on the 12th of November, Stephanie delivered a baby girl weighing a small weight – premature, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been provided a few hours prior to birth.

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

Stephanie had sought recovery several times during pregnancy, and felt awful each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became clearly expecting.

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

The common assumption that her affection for her child would make her quit only led to deeper self-loathing and negative self-talk, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to monitors, so tiny she thought she would hurt her. Embracing her at last, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like this facility is proving a simple point: when parents and infants remain united, results get better, foster placements fall and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to collect her.

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

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At Maddie’s Place, Stephanie still feared that CPS would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could enter and remove her child.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about getting by. Substances came first; trust came last.

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

Each day, staff from the facility transported her to a recovery program, administered in pill form. Slowly, she was embracing sobriety.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention 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 heightened sensory issues and required an specialist – all common issues for babies exposed to substances.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a cap with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her face is downcast so you do not see her expression. She is holding Izzie up on her knee for the other kids to see and they are standing close, admiring and touching to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The women attempted to clarify 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. “When a child recognized that infants need affection, then I was able. I would become a mother.”

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

The Finnegan NAS scale was established in 1975|