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In her eighth month of pregnancy and suffering, a woman named Stephanie went to the medical facility after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had built in a friend’s yard. She was also dependent on fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and vomited.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to figure out how to get clean and deliver her child.

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

“I am leaving,” Stephanie said.

But the doctors would not let her go: the leg infection was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.

Five days later, on a day in November 2022, Stephanie had a infant weighing 4lb 8oz – born before term, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her last dose of fentanyl had been given shortly before she gave birth.

She felt ill. Ill-equipped for parenting. Undeserving.

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she relapsed. She felt without value, berating herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source declined to supply to her when she became clearly expecting.

“Yet I was unable,” she said. “I had to seek support.”

The pervasive expectation that her love for her baby would make her recover only led to greater shame and self-harm, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The baby was taken to the NICU. When Stephanie finally saw her her, she was attached to medical equipment, so small she thought she would break her. Cradling her initially, 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 call her daughter after her caregiver, after the nurse who had been so kind to her.

Hospital staff told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when families are kept intact, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

She left the medical center still in recovery, fearful and unsure about what would come next.

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At Maddie’s Place, Stephanie still was concerned that child services 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 take her baby away.

For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about enduring. Substances came first; reliance came last.

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

Every day, staff from Maddie’s Place took her to a treatment center, administered in pill form. Over time, she was starting to get clean.

She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all typical problems for babies affected by withdrawal.

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

During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a peer support specialist, visited with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is dressed in casual attire, a cap with a decoration on her head, resting on the floor with the door behind her. She is lean. Her posture is humble so you do not see her expression. She is lifting the baby on her lap for the young ones to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the fathers had obligations, handling responsibilities, 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 looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could be a mom.”

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Approaches for managing infants affected by substances have been available for years.

The assessment tool was created in 1975|