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Pregnant and experiencing intense discomfort, the expectant mother went to the ER after her infection worsened up her legs. Without a job or home, estranged from her family, she resided in a small structure she had constructed in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.

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 coming to the ER and had only a brief window to get treated before she was compelled to leave 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 staying put.

“I will go,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.

After five days, on the 12th of November, Stephanie gave birth to a baby girl weighing 4lb 8oz – born before term, little but surviving.

When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been given shortly before she gave birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her source refused to sell to her when she became visibly pregnant.

“However, I failed,” she said. “I required assistance.”

The widespread belief that her affection for her child would make her stop using only led to deeper self-loathing and self-harm, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to monitors, so small she thought she would harm her. Cradling her initially, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to name her baby after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition 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 proving a simple point: when families are kept intact, results get better, foster placements fall and overall savings increase.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.

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

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At the care center, Stephanie still feared that CPS would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and take her baby away.

For the initial fortnight, 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 getting by. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She was unable to love herself, let alone anyone else.

Daily, staff from Maddie’s Place drove her to a clinic for methadone, given as medication. Slowly, she was embracing sobriety.

She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an professional – all common issues for babies affected by withdrawal.

When a child recognizes these infants need affection, then I was capable. I could parent.

During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a mentor, visited with her own children 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 small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is dressed in casual attire, a gray knit hat with a bobble on her head, resting on the floor with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are standing close, fawning and reaching out to the baby.

One child, eight, asked the mothers: “Why are there no men?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there given the chance.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.”

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Methods to address infants affected by substances have been used for a long time.

The evaluation method was developed in 1975|