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Eight months pregnant and in severe pain, a woman named Stephanie went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and threw up.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and give birth.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

A short time later, on a day in November 2022, Stephanie delivered a baby girl weighing just over four pounds – born before term, tiny yet healthy.

When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was detached. Her epidural had failed, her last dose of fentanyl had been given four hours before delivery.

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

Stephanie had sought recovery several times during pregnancy, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her source would not provide to her when she became obviously with child.

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

The widespread belief that her love for her baby would make her recover only led to increased guilt and negative self-talk, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to medical equipment, so little she thought she would hurt her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to give her child the name the same as her nurse, after the nurse who had been so kind to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, results get better, custody cases decrease and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

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

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At the facility, Stephanie still feared that authorities would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could enter and separate them.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about survival. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to cause pain. She was unable to love herself, let alone anyone else.

Every day, staff from the facility drove her to a recovery program, given as medication. Slowly, she was beginning recovery.

She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all typical problems for babies born with NAS.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, visited with her own children in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her posture is humble so you do not see her expression. She is holding Izzie up on her knee for the children to see and they are crowding near, showing interest to the baby.

A young boy, eight, asked the moms: “What about the fathers?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I would become a mother.”

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Tools for treating infants affected by substances have existed for decades.

The assessment tool was developed in 1975|