The Five R’s in Providing the Best-Care to Pregnant People with Substance Use Order (SUD)

Disclaimer: All information presented was taken from Alliance for Innovation on Maternal Health (AIM) and meant to serve as guidelines for healthcare providers, community-based organizations, clinics, or any professional seeking to provide best-practices to pregnant/birthing individuals and families with substance use disorder (SUD).


  • Provide education on substance use disorder (SUD) naloxone use, harm reduction strategies, and care of infants with in-utero substance exposure.
  • Develop trauma-informed protocols and anti-racist trainings to address any biases or stigmas that health care team members may have.
  • Provide clinical and non-clinical staff education on best-care practices that include federal, state, and local reporting guidelines for infants with in-utero substance exposure and comprehensive family care plans.
  • With the assistance of key partners, provide family care plans.
  • Create multidisciplinary teams to provide coordinated clinical services for people experience SUD.
  • Keep a detailed set of referrals between any appropriate parties to connect pregnant and postpartum individuals to services and support to enhance their care and treatment.

Recognition and Prevention

  • Screen all pregnant and postpartum people:
  • With substance use disorder (SUD) during perinatal and after delivery using self-reported screening tools.
  • For medical and behavior health needs to help link to community services and resources.
  • For structural and social determinants of health that might impact care or delivery of services.


  • Implement evidence-based treatment that is welcoming, inclusive, and intersectional. Be prepared to refer treatment with a warm hand-off and a close follow-up.
  • Establish prenatal, intrapartum (during childbirth), and postpartum care connections with multiple providers during pregnancy as well as one year postpartum.
  • Offer comprehensive reproductive life planning counseling, discussions, and resources.

Reporting and Systems Learning

  • Identify and monitor data related to SUD treatment and care outcomes and process metrics.
  • Share successful strategies and identify opportunities to improve outcomes and other systemic issues amongst providers, stakeholders, and those with lived experiences.

Respectful, Equitable, and Supportive Care

  • Engage in open, transparent, and empathetic communication with pregnant and postpartum individuals including their support system.
  • Integrate pregnant and postpartum persons as part of the multidisciplinary team to help create trust and promote informed, shared decisions.
  • Respect each person’s right or refusal that aligns with their values and goals.