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Eight months pregnant and in severe pain, a woman named Stephanie arrived at the medical facility after her infection worsened up her legs. Without a job or home, separated from loved ones, she lived in a shed she had constructed in a acquaintance's garden. She was also hooked on fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and vomited.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”

She had taken the drug before arriving at the hospital and had only a brief window to get treated before she needed to go home to relapse. She thought she still had a month remaining to find a way to become sober and have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

After five days, on the 12th of November, Stephanie delivered a baby girl weighing 4lb 8oz – early, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been provided a few hours prior to birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had sought recovery repeatedly before birth, and felt horrible each time she relapsed. She felt without value, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her source would not provide to her when she became clearly expecting.

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

The pervasive expectation that her affection for her child would make her recover only led to greater shame and negative self-talk, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the NICU. When Stephanie at last met her, she was attached to tubes and leads, so small she thought she would break her. Embracing her at last, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where women and their babies are treated together, not apart.

In numerous states, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and medicated 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 mothers and babies stay together, results get better, foster placements fall and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to collect her.

She departed the institution still in detox, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still feared that child services would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and take her baby away.

For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”

Homelessness, she said, was about enduring. Substances came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to hurt her. She was unable to value herself, much less anyone else.

Each day, staff from Maddie’s Place took her to a recovery program, provided orally. Slowly, she was beginning recovery.

She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all common issues for babies exposed to substances.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. An advocate, a mentor, stopped by with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She holds a picture of the moment. She is dressed in casual attire, a beanie with a bobble on her head, sitting on the wooden floor with the door behind her. She is lean. Her face is downcast so you do not see her expression. She is lifting the baby on her lap for the young ones to see and they are gathered around, showing interest to the baby.

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

“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.”

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Tools for treating drug-exposed newborns have been available for years.

The evaluation method was created in 1975|