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Eight months pregnant and in severe pain, the expectant mother went to the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had built in a friend’s yard. She was also hooked on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she needed to go home to relapse. She thought she still had several weeks to find a way to become sober and give birth.

The medical professional intervened. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the leg infection was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used 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 attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her epidural had failed, her previous intake of fentanyl had been provided four hours before delivery.

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

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her supplier refused to sell to her when she became obviously with child.

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

The common assumption that her love for her baby would make her recover only led to deeper self-loathing and self-abuse, a trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.

The baby was taken to the special care nursery. When Stephanie at last met her, she was hooked up to tubes and leads, so tiny she thought she would harm her. Holding her for the first time, she felt empty. “I gazed upon 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 call her daughter Izzie, after the professional who provided support to her.

Hospital staff told her about a specialized facility, 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 diagnosed with infant withdrawal condition frequently, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a small, growing network of centers like the care home is proving a simple point: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to collect her.

She left the medical center still in withdrawal, fearful and unsure about what would happen next.

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At Maddie’s Place, Stephanie still feared 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 point, someone could enter and take her baby away.

For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about getting by. Addiction came first; faith came last.

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She was unable to love herself, let alone anyone else.

Each day, staff from the center transported her to a recovery program, administered in pill form. Slowly, 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 intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an professional – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. A support specialist, a peer support specialist, came over with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is dressed in black pants and a hoodie, a cap with a bobble on her head, sitting on the wooden floor with the exit nearby. She is slender. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the other kids to see and they are crowding near, showing interest to the baby.

One child, eight, asked the parents: “What about the fathers?” The parents responded that the dads were busy, handling responsibilities, that they would be there if possible.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could parent.”

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Tools for treating infants affected by substances have been available for years.

The assessment tool was developed in 1975|