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In her eighth month of pregnancy and suffering, the expectant mother arrived at the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had assembled in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and vomited.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”

She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to figure out how to get clean and give birth.

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

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the leg infection was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.

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

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been administered four hours before delivery.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she relapsed. She felt hopeless, berating herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her source would not provide to her when she became visibly pregnant.

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

The common assumption that her affection for her child would make her stop using only led to greater shame and negative self-talk, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.

The baby was taken to the special care nursery. When Stephanie eventually visited her, she was hooked up to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to call her daughter Izzie, after the nurse who had been so kind to her.

Medical personnel told her about Maddie’s Place, a new kind of care center where women and their babies are treated together, not apart.

In many parts of America, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is proving a simple point: when families are kept intact, results get better, foster placements fall and overall savings increase.

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 collect her.

She stepped out of the hospital still in recovery, anxious and doubtful about what would follow.

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At the facility, Stephanie still was concerned that authorities would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could walk in and remove her child.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about getting by. Substances came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to love herself, let alone anyone else.

Each day, staff from Maddie’s Place drove her to a recovery program, provided orally. Slowly, she was starting to get clean.

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 pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an specialist – 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 would become a mother.

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for supervised visits with their babies. A support specialist, a peer support specialist, visited with her own family in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”

She has an image of the moment. She is dressed in casual attire, a gray knit hat with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her face is downcast so you cannot see her face. She is holding Izzie up on her leg for the children to see and they are gathered around, admiring and touching to the baby.

One child, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there given the chance.

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

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I would become a mother.”

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Methods to address drug-exposed newborns have been used for a long time.

The assessment tool was developed in 1975|