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Pregnant and experiencing intense discomfort, the expectant mother went to the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she lived in a shed she had built in a companion's property. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and became sick.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”

She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

A short time later, on the 12th of November, Stephanie delivered a daughter weighing just over four pounds – premature, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her epidural had failed, her last dose of fentanyl had been provided four hours before delivery.

She felt ill. Not ready for motherhood. Undeserving.

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

“Yet I was unable,” she said. “I needed help.”

The pervasive expectation that her love for her baby would make her recover only led to deeper self-loathing and negative self-talk, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was hooked up to monitors, so tiny she thought she would break her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to name her baby Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about a specialized facility, a unique recovery environment 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 whisked to NICUs and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to pick her up.

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

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At Maddie’s Place, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could walk in and remove her child.

For the first two weeks, Stephanie stayed withdrawn. “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 getting by. Drugs came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The people she loved always found ways to let her down. She lacked the ability to love herself, let alone anyone else.

Every day, staff from the center transported her to a recovery program, administered in pill form. Gradually, 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 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 professional – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I could do this. I would become a mother.

On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. An advocate, a peer support specialist, came over with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The young ones stared in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is dressed in black pants and a hoodie, a beanie with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her head is tilted forward so you cannot see her face. She is lifting the baby on her knee for the children to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there if they could.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could parent.”

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Tools for treating babies with exposure have existed for decades.

The assessment tool was created in 1975|