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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. Without a job or home, cut off from her relatives, she resided in a small structure she had built in a companion's property. She was also dependent on fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and threw up.

Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she had to return to relapse. She thought she still had a month remaining to find a way to become sober and deliver her child.

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

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.

A short time later, on the 12th of November, Stephanie had a infant weighing 4lb 8oz – early, small but alive.

When the nurse asked if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been given shortly before she gave birth.

She felt sick. Not ready for motherhood. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she was unsuccessful. She felt without value, berating herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her dealer declined to supply to her when she became visibly pregnant.

“Yet I was unable,” she said. “I required assistance.”

The pervasive expectation that her affection for her child would make her quit only led to greater shame and negative self-talk, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was connected to monitors, so tiny she thought she would harm her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to give her child the name the same as her nurse, after the nurse who had been so kind to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, results get better, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to pick her up.

She departed the institution still in withdrawal, anxious and doubtful about what would follow.

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At the facility, Stephanie still feared that CPS would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could enter and take her baby away.

For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”

Homelessness, she said, was about survival. Substances came first; reliance came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She did not know how to care for herself, let alone anyone else.

Each day, staff from the center took her to a recovery program, given as medication. Slowly, she was beginning recovery.

She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a cap with a bobble on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast so you cannot see her face. She is lifting the baby on her leg for the young ones to see and they are standing close, showing interest to the baby.

One child, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there given the chance.

“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 was able. I could be a mom.”

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Approaches for managing infants affected by substances have been used for a long time.

The assessment tool was created in 1975|