Tricia Hughes smiles as a 3-week-old infant turns to gaze up at her. A former nurse, Hughes looks for reasons to beam beyond the warmth of holding a baby.

Healthy newborns will set eyes on an adult face soon after birth, she said. A longtime foster mom, Hughes knows from experience that for drug- and alcohol-exposed infants, such a reaction isn’t common. Faces and other stimuli – abrupt moves, lights, noises – are overwhelming.

She also learned firsthand that those babies can have recovery through trained caregiving, comfort techniques, careful feeding and frequent human touch – all provided at first in a quiet, calm and darkened space.

Hughes worked five years to create a Spokane medical facility to provide such newborn withdrawal care, and when possible, support and training for the mom or adult caregiver.

Maddie’s Place, a name inspired by Hughes’ care of an adopted child, opened here Oct. 3 as one of four pediatric transitional care facilities in the U.S.

Camille Curry, who nominated Hughes as one of this year’s Women of the Year, called Hughes the heart and drive behind Maddie’s Place.

“She has been not only the inspiration, but a tireless worker and leader,” Curry wrote. “This has been a very complex program to start and she has mounted every challenge with a positive outlook and a determination to find the resources necessary.”

Tricia Lord wrote in her nomination letter for Hughes: “(She) saw the need, did the research, got the funding, remodeled the building, built a Board and staff and volunteer program.

“She has brought Spokane a most-needed service.”

About 10-15% of babies have been exposed to a mother’s drug use, Hughes said.

Hospital nurses know it’s higher, she said, “especially if you count marijuana, which does its own kind of special disaster on a baby’s brain and stomach.”

Among about 6,000 live births a year in Spokane, she estimates at least 2,000 are born substance-exposed. Maddie’s Place, licensed by the state Department of Health, has eight infant rooms and a nursery in the remodeled former Vanessa Behan facility.

In the first week, Maddie’s Place received three newborns. Staff includes a nurse and two infant care specialists, and Hughes as clinical director, offering guidance and training.

Hughes has a heart for babies. A longtime doula, she’s attended over 300 births.

In the 1990s, she worked as a labor and delivery nurse and with high-risk pregnancies in Wisconsin and Illinois.

The Hughes family, with four children, moved to Spokane in 1999. She and her husband Carey wanted to adopt and became foster parents to a 14-month-old infant boy exposed to heroin and alcohol. He’s among their five adopted children, all born exposed.

Four of them received care initially elsewhere, but that wasn’t the case with Maddie, now 14, who arrived in the Hughes home at 18 days old. She’d lived on the streets with her biological mom until authorities brought her to caretakers. A social worker learned the Hughes family already had Maddie’s sister.

“Maddie came late at night, and I very quickly knew something was really wrong,” Hughes said.

She had tremors and gut issues. Hughes figured out she only calmed when held to the chest, and then used a cloth wrap to carry Maddie there almost constantly.

“For the first three months, she pretty much lived there,” Hughes said.

“Maddie was 5½ weeks old before she could look into my eyes. She would arch almost out of your arms to avoid looking at your face. It was too stimulating.”

Today, affected infants are typically exposed to more than one drug while their mothers are pregnant. That exposure causes neurobehavioral changes, she said.

“They all have changes in the brain while they were developing and growing. It looks different for every baby. They all need to be put in a little bubble, to protect them, handle them in a certain way, meet every need – every time they’re crying, they get attention, not medication.

“You gradually start to build their tolerance to the world and gradually expose them to more sound, light. You start with touch, because that is the most important.”

Hughes knows this taps into research on premature babies, to help their brains regulate and organize. Exposed newborns’ brains also aren’t ready at first, she said. But all newborns are primed to be cuddled close.

“I believe that’s where every baby should be whenever possible, and our babies even more so,” she said. “We know the power of human touch. We can use medication if we need it, but a lot of it is the way we handle them.”

Hughes advocates the first two months of life are crucial in building a perspective of the world, as a baby cries or has needs. Comforting responses become roots of feeling good and safe.

“If we don’t protect that time, I believe we’re living with the ramifications of not protecting that time,” she said. “It’s not a secret that we have a huge issue with homelessness, substance use and relationships.

“The relationship piece really has been surfacing lately in homelessness research – that they have broken relationships in their lives. Well, if babies don’t learn how to attach from the moments they’re born, it just stands to follow that they have relationship problems later.”

After Maddie’s arrival, her husband suggested she figure out how to replicate herself and train others as opposed to her trying to save all exposed babies. It planted a seed.

As their kids got older, her husband encouraged the leap, so Hughes called a meeting of people she’d met from fostering and in health. Among them, a neonatologist later called. He found a medical study on Lily’s Place, in West Virginia, with the withdrawal care that Hughes described.

She also learned about Brigid’s Path in Ohio. Maddie’s Place leaders had planned six additional infant rooms, abandoned as of now under building rules and costs.

Prior to opening, someone broke in and stole all the facility’s electronics. Responding officers got a tour of the facility and told staff they didn’t think there were enough rooms.

Hughes knows that, but the goal is to get started. She likes the hashtag: #Startwiththebabies.

“I love babies because they represent an opportunity,” she said. “We have an opportunity to establish a safe world for someone. That’s a huge responsibility, and it’s a huge opportunity to start them off right.”