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Eight months pregnant and in severe pain, a woman named Stephanie went to the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and became sick.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had several weeks to plan her recovery and have this baby.

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 medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

A short time later, on a day in November 2022, Stephanie delivered a baby girl weighing just over four pounds – premature, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had sought recovery multiple times while expecting, and felt terrible each time she was unsuccessful. She felt hopeless, berating herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

“However, I failed,” she said. “I needed help.”

The common assumption that her bond with her newborn would make her recover only led to deeper self-loathing and self-harm, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was attached to tubes and leads, so tiny she thought she would break her. Cradling her initially, she felt detached. “I looked at 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 name her baby after her caregiver, after the nurse who had been so kind to her.

Nurses and doctors told her about a care center, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to bring her to the facility.

She stepped out of the hospital still in detox, scared and uncertain about what would come next.

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At Maddie’s Place, Stephanie still worried that authorities would come seize her child – even though she was not sure she wanted to keep her. 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 didn’t have a lot of trust at that point.”

Homelessness, she said, was about survival. Addiction 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 cause pain. She was unable to love herself, let alone anyone else.

Daily, staff from Maddie’s Place transported her to a treatment center, provided orally. Gradually, she was beginning recovery.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all frequent conditions for babies affected by withdrawal.

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 individuals struggling with substance use can come for guided meetings with their babies. A support specialist, a mentor, stopped by with her own children in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in awe 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. None of those things mattered to them.”

She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, sitting on the wooden floor with the door behind her. She is thin. Her face is downcast so you do not see her expression. She is lifting the baby on her knee for the children to see and they are gathered around, admiring and touching to the baby.

One child, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there if they could.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. 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. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”

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Methods to address infants affected by substances have existed for decades.

The Finnegan NAS scale was developed in 1975|