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Eight months pregnant and in severe pain, the expectant mother went to the hospital emergency room after her infection worsened up her legs. Without a job or home, estranged from her family, she lived in a shed she had assembled in a acquaintance's garden. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and threw up.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had four weeks left to find a way to become sober and give birth.

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 leg infection was serious, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would not survive.

She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

A short time later, on the 12th of November, Stephanie delivered a daughter weighing 4lb 8oz – early, small but alive.

When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.

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

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she failed. She felt without value, berating herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her dealer would not provide to her when she became clearly expecting.

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

The pervasive expectation that her bond with her newborn would make her quit only led to deeper self-loathing and self-abuse, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to tubes and leads, so little she thought she would harm her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

After two days she decided to call her daughter the same as her nurse, after the professional who provided support to her.

Nurses and doctors told her about a specialized facility, a new kind of care center where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition frequently, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.

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 pick her up.

She departed the institution still in withdrawal, fearful and unsure about what would happen next.

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At the facility, Stephanie still feared that authorities would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could walk in and separate them.

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

Survival outdoors, she said, was about enduring. Substances came first; trust came last.

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

Every day, staff from the center transported her to a treatment center, provided orally. Over time, she was starting to get clean.

She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own family in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The young ones stared in awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She keeps a photo of the moment. She is clad in casual attire, a beanie with a pompom on her head, resting on the floor with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her knee for the other kids to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the mothers: “Why are there no men?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could parent.”

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Approaches for managing drug-exposed newborns have been available for years.

The evaluation method was developed in 1975|