Frequently Asked Questions About Substance Use in Pregnancy

Pregnant woman and husband holding

I was lucky that my husband's mother has been very supportive throughout the whole thing. She would help me do research and stuff. And she was one of those people you would think wouldn't be supportive. But she turned out to actually be my biggest advocate.

Patient who received our prenatal care

Your maternity care team is here to support you in having a healthy pregnancy and a healthy baby. We're here to help you and your baby go home together to a safe place. The best way to make this happen is to get prenatal care early!

Many people with a history of substance use have questions and worries about child protective services:

  • DCYF (Division for Children, Youth, and Families) in New Hampshire
  • DCF (Division of Children and Families) in Vermont

We collected the most frequently asked questions that you have asked and share our honest answers with you.

Note: Please be aware the information presented here is informational only, and is not legal or medical advice. Medical advice should be obtained from your treating provider, and legal advice should be obtained from an attorney who is aware of your unique circumstances and familiar with the current law.

What, if any, criminal ramifications might someone face if they are determined to be using substances while pregnant?

In Vermont and New Hampshire, using drugs or alcohol during pregnancy is not a distinct and separate crime. Under the current law, no one should face any different legal charges because they use substances when they are pregnant in these states.

Are the things I tell my providers confidential?

A health care provider will not disclose or share your health information with another person outside of your care team without your written consent, unless they are allowed to or required to by law. However, if a provider writes something in your medical record, it can be read by other providers who care for you or your baby.

If you are a patient of ours, the Notice of Privacy Practices describes when we can disclose or share your information without your written consent.

Can women start taking medications for opioid use disorder during pregnancy?

Yes, both buprenorphine (including buprenorphine/naloxone formulations such as Suboxone or Zubsolv) and methadone are safe and work well during pregnancy. Both medications are recommended during pregnancy when medication for opioid use disorder is needed to support recovery.

I don't want to tell my doctor I am using. How will they know?

Our policy is that a drug test should not be performed without your knowledge and verbal consent. If a person is unconscious, a provider can order a drug test to provide necessary medical care. Drug tests are sometimes requested when bleeding, preterm labor, or other pregnancy complications occur or if a person seems intoxicated or has withdrawal symptoms.

However, a parent's consent is not required to order a drug test for a baby. After a baby is born, the baby's provider may decide to send urine, meconium (baby's first poop), or a piece of the baby's umbilical cord for drug testing. Meconium and umbilical cord tests can detect what the baby was exposed to during the last three months of pregnancy.

Is there a way to anonymously ask a doctor or midwife questions?

Yes! Anyone can call the Perinatal SUD Helpline (603-650-2602) and tell the person who answers that they have questions for a midwife or doctor but don't want to give their name. Our staff will then help find a midwife or nurse to talk to you right away if possible or arrange a time for them to call you back.

Can I take Subutex if I join the Moms in Recovery program?

The Moms in Recovery program prescribes only Suboxone during pregnancy or postpartum. After pregnancy is over, some people choose to switch to long-acting injectable buprenorphine (as a monthly shot).

What if Suboxone makes me sick to my stomach?

If Suboxone makes you feel sick to your stomach during pregnancy, switching from strips to tablets or trying a different flavor or brand can often help. If you still have problems with nausea or feeling sick to your stomach, your provider can prescribe a medication to help with this.

Are there resources and options for residential treatment and/or safe housing for pregnant women whose substance use is closely connected with their living/relationship situation?

Yes. If a pregnant person needs residential treatment, there are 28-day residential treatment programs in New Hampshire and Vermont that will accept people who are pregnant, but not their children. There are very few options for residential treatment that allow mothers to bring their children: two in southern New Hampshire, and one in northwestern Vermont. If a pregnant or parenting person needs safe housing due to domestic violence but does not need residential treatment for substance use, there are safe housing options through WISE and Turning Points.

Is childcare available during medical care visits?

Nursing staff do their best to help with children during prenatal and postpartum visits when they can, but this is not the same as having childcare. For safety reasons, children are not allowed to come to an ultrasound appointment.

Will my baby be taken away from me if I admit to using drugs?

Using substances during or after your pregnancy does not mean that your baby will be taken away from you. However, if a parent is actively using substances and a medical provider thinks that substance use may put the baby, or any other children at home, at risk for harm or neglect, the provider is required to make a report to child protective services. This is known as a "mandated report."

If a report is made to child protective services, this does not necessarily mean that they will remove your baby from your custody, especially if you are connected to a treatment program and working on your recovery, and there is a sober caregiver around to take care of your child.

Cannabis (marijuana) use by itself is not usually the reason for a report.

When does child protection get called, and who calls?

Child Protection (DCYF/DCF) is called when there is concern a baby is at risk of harm or neglect. 

Usually, a hospital social worker, doctor, or nurse calls after a baby is born. It is different in Vermont; Vermont DCF recommends that a report be made in the third trimester if the pregnant mother is using non-prescribed drugs, with the exception of cannabis.

But if you leave a treatment program or if you continue to use non-prescribed drugs, or if the medical team thinks there is a risk to another child in the home, they may call earlier.

All health care providers are mandated reporters, which means they are legally required to call child protective services if they think there is a risk of harm or neglect to a child.

If a report needs to be made to child protection, the medical team will do its best to talk with you about their concerns.

What happens when DCYF/DCF gets involved?

There are several steps in this process. After a call is received by DCYF/DCF, the agency will decide whether follow up is needed. If so, a case worker is assigned who contacts the family about the reported safety concerns. Once a case is assigned the length of time that it remains open varies according to what the case worker finds.

New Hampshire DCYF and Vermont DCF have similar processes after a report is made.

For more information, see "Where can I learn more about DCYF and DCF"?

What are the specific circumstances where I can lose my baby?

New Hampshire DCYF and Vermont DCF each have their own process for investigating and acting on reports. Generally, child protection can remove a baby from the parent's custody if there is a reasonable concern that the child is at risk for serious harm or neglect. This may include:

  • A parent using a drug that could cause them to overdose
  • A parent using a drug that could make them not be able to safely care for their baby
  • Violence in the home
  • Presence of drugs in the home that could pose risk to the infant or other children

What is a Plan of Safe Care (POSC)?

The federal government requires a customized Plan of Safe Care (POSC) to be created for the family when a baby is born affected by substances used during pregnancy.

The POSC helps a family to connect with services they need once they go home with their baby. The plan also provides a list of contact information for programs and services.

Other information in the POSC includes:

  • Members of the household
  • Prenatal substance exposure
  • Strengths and goals

In New Hampshire and Vermont, a POSC is a separate requirement. Having a POSC created does not itself cause a report to the DCYF/DCF.

Where can I learn more about DCYF and DCF?

For more information, please see the following websites and documents:

New Hampshire DCYF

Vermont DCF