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In her eighth month of pregnancy and suffering, a woman named Stephanie went to the ER after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and threw up.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had taken the drug before seeking medical help and had just enough time to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and have this baby.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.

Five days later, on the 12th of November, Stephanie had a daughter weighing 4lb 8oz – early, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was numb. Her epidural had failed, her last dose of fentanyl had been given shortly before she gave birth.

She felt ill. Unprepared to be a mother. Not fit.

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.

“However, I failed,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her recover only led to deeper self-loathing and self-harm, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was connected to medical equipment, so tiny she thought she would hurt her. Holding her for the first time, she felt nothing. “I gazed upon 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 name her baby the same as her nurse, after the nurse who had been so kind to her.

Nurses and doctors told her about a care center, a new kind of care center where women and their babies are treated together, not apart.

In numerous states, where a baby is diagnosed with newborn addiction symptoms regularly, 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 Maddie’s Place is showing an important truth: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to pick her up.

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

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At Maddie’s Place, Stephanie still feared that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could arrive and separate them.

For the first two weeks, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about enduring. Drugs came first; trust came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to care for herself, not to mention anyone else.

Daily, staff from the center took her to a treatment center, provided orally. Slowly, she was starting to get clean.

She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an specialist – all frequent conditions for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own children in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing casual attire, a cap with a pompom on her head, sitting on the wooden floor with the exit nearby. She is thin. Her face is downcast so you miss her features. She is presenting her daughter on her knee for the young ones to see and they are standing close, showing interest to the baby.

One child, eight, asked the parents: “What about the fathers?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I would become a mother.”

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

The assessment tool was established in 1975|