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Pregnant and experiencing intense discomfort, a woman named Stephanie visited the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and vomited.

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

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had several weeks to figure out how to get clean and have this baby.

The attending nurse disagreed. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the leg infection was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded 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 placed on methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.

After five days, on the 12th of November, Stephanie had a daughter weighing just over four pounds – premature, little but surviving.

When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been provided four hours before delivery.

She felt ill. Unprepared to be a mother. Undeserving.

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she failed. She felt without value, berating herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her source would not provide to her when she became visibly pregnant.

“But I couldn’t,” she said. “I required assistance.”

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

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was hooked up to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt detached. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

After two days she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about a specialized facility, a innovative treatment home where women and their babies are treated together, not apart.

In many parts of America, where a baby is found to have infant withdrawal condition regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She left the medical center still in detox, anxious and doubtful about what would follow.

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At Maddie’s Place, Stephanie still worried that child services would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could walk in and separate them.

For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about getting by. Drugs came first; reliance came last.

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

Daily, staff from the facility took her to a clinic for methadone, given as medication. Over time, she was starting to get clean.

She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had sensory challenges and required an specialist – all common issues for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I could parent.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, visited with her own children in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a pompom on her head, resting on the floor with the exit nearby. She is lean. Her face is downcast so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are gathered around, showing interest to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there if possible.

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

Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I would become a mother.”

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Methods to address babies with exposure have been available for years.

The assessment tool was created in 1975|