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Eight months pregnant and in severe pain, a woman named Stephanie arrived at the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

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

The nurse had other ideas. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection was severe, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.

Five days later, on the 12th of November, Stephanie delivered a infant weighing just over four pounds – born before term, small but alive.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been provided a few hours prior to birth.

She felt unwell. Ill-equipped for parenting. Unworthy.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she relapsed. She felt worthless, blaming herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her dealer refused to sell to her when she became clearly expecting.

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

The pervasive expectation that her bond with her newborn would make her recover 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 baby was taken to the NICU. When Stephanie at last met her, she was hooked up to medical equipment, so little she thought she would harm her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

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

Hospital staff 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 diagnosed with infant withdrawal condition frequently, 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 this facility is proving a simple point: when mothers and babies stay together, outcomes improve, foster placements fall and long-term costs decline.

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, two staff members came to collect her.

She left the medical center still in detox, scared and uncertain about what would come next.

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At the facility, Stephanie still worried that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any point, someone could walk in and separate them.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about enduring. Drugs came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to let her down. She lacked the ability to love herself, not to mention anyone else.

Each day, staff from the facility transported her to a treatment center, provided orally. Slowly, she was beginning recovery.

She spent every minute outside treatment 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 nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies born with NAS.

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

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for supervised visits with their babies. An advocate, a mentor, visited with her own family in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in awe 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 holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the other kids to see and they are standing close, fawning and reaching out to the baby.

Jacob, eight, asked the moms: “Why are there no men?” The parents responded that the men were occupied, handling responsibilities, 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 Bunch-Smith looked at each other. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I would become a mother.”

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Tools for treating infants affected by substances have been available for years.

The assessment tool was created in 1975|