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Eight months pregnant and in severe pain, a woman named Stephanie went to the ER after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had constructed in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital 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 figure out how to get clean and have this baby.

The nurse had other ideas. 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 critical, but medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.

A short time later, on a day in November 2022, Stephanie delivered a baby girl weighing just over four pounds – born before term, tiny yet healthy.

When the caregiver questioned if she wanted to hold her baby, 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 ill. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to overcome the challenge. An OBGYN told her to “simply” 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 affection for her child would make her quit only led to increased guilt and negative self-talk, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the NICU. When Stephanie at last met her, she was hooked up to medical equipment, so tiny she thought she would harm her. Holding her for the first time, she felt nothing. “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 name her baby Izzie, after the professional who provided support to her.

Hospital staff told her about a care center, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition regularly, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like this facility is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to collect her.

She departed the institution still in recovery, anxious and doubtful about what would come next.

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At the care center, 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 enter and take her baby away.

For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

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

Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to let her down. She lacked the ability to care for herself, not to mention anyone else.

Each day, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Over time, she was embracing sobriety.

She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all frequent conditions for babies born with NAS.

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

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a peer support specialist, stopped by with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet 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 holds a picture of the moment. She is wearing casual attire, a cap with a bobble on her head, resting on the floor with the exit nearby. She is thin. Her head is tilted forward so you miss her features. She is lifting the baby on her lap for the children to see and they are crowding near, showing interest to the baby.

One child, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. 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 developed in 1975|