Say it first, even if it is hard
When you contact a treatment service, mention the pregnancy at the start of the conversation. It changes the medical questions, the medications that are suitable and which programs can accept you. A program that is right for someone else may not be equipped for prenatal care.
You may be afraid of judgment, or of what might happen with your family or children. Those fears are real, and NIDA's research report on women in treatment names fear of losing children as one reason some pregnant women and mothers avoid treatment. You can ask a program directly how it handles privacy and what, if anything, it is required to report. Rules differ by state and circumstance, and this guide cannot tell you what applies to you. What is clear is that the medical risks of going without care are serious.
Why stopping suddenly is not the answer
NIDA's research report on substance use disorder treatment in women says a pregnant woman should ask for medical help to stop her drug use. If she tries to withdraw suddenly from addictive drugs or alcohol without medical help, it says, she could be putting her fetus at risk.
That can feel like the opposite of what you want to hear when your instinct is to stop everything immediately. The point is not to keep using. It is to stop in a way that is safe for both of you, with medical support.
The same caution applies to prescribed medicines. NIDA's report on substance use while pregnant and breastfeeding notes that suddenly stopping a medication can be more risky than continuing, and that this can include medications to treat substance use disorders. Talk to your prescriber and prenatal provider before making any change.
Opioids and pregnancy
NIDA's page on medications for opioid use disorder says treatment with methadone or buprenorphine is recommended for pregnant women with opioid use disorder. It notes that buprenorphine may lead to better health outcomes for infants than methadone, and that these medications are also safe during breastfeeding.
NIDA's report on women's treatment says it is generally neither recommended nor necessary for pregnant women already on methadone or buprenorphine to stop. If you are already taking one, do not stop because you are pregnant. Tell the prescriber and your prenatal provider so they can work together.
NIDA explains that babies exposed to opioids before birth may have withdrawal symptoms after birth, known as neonatal opioid withdrawal syndrome, and should be monitored and treated if needed. Ask your providers what to expect after delivery and what care the baby may need.
Alcohol and pregnancy
NIAAA's page on alcohol and pregnancy says there is no known safe amount of alcohol during pregnancy, including early on, and advises stopping now because every day matters. It says options for pregnant women include behavioral treatment and mutual-support groups.
If you have been drinking heavily and regularly, stopping suddenly can cause withdrawal. Ask a doctor how to stop safely rather than doing it alone.
Some medications sometimes used for alcohol problems are not suitable in pregnancy. ASAM's handout on medications for alcohol use disorder says topiramate and gabapentin should not be taken if pregnant. Any medication decision needs to go through your prescriber, with the pregnancy in mind.
What a program should provide
NIDA's report on women's treatment notes several things worth knowing when you contact programs. It says federal law requires that pregnant women receive priority admission to publicly funded substance use disorder treatment programs. It says that in those programs the primary treatment provider must arrange prenatal care if a pregnant woman is not already receiving it. And it says programs that offer child care, parenting classes and job training help pregnant women stay in treatment.
When you call, ask whether the program treats pregnant patients and how it coordinates with prenatal care. Ask whether it provides or allows methadone or buprenorphine where relevant, and what support it offers after delivery. If you already have children, ask what help exists with child care so that treatment is something you can actually attend.
Plan for after the birth
The weeks after delivery bring new stress, broken sleep and changes to routine. Before the birth, ask who will continue your treatment afterward, how medication will be managed and whom to contact if you are struggling.
Ask about breastfeeding and your medication, and about mental health support after the birth. Keep your prenatal provider, your treatment prescriber and your baby's doctor informed, so no one makes a decision without the full picture.
It is not too late to get help
Whatever has happened so far, NIAAA's advice for alcohol is that treatment is an ongoing process and that it is worth trying again even if you have been through treatment before. You do not need to have everything worked out before asking a doctor or treatment service for help.
Activities from this guide
Your checklist
Read the steps now. A free account lets you save your own checklist.
- 1. Tell the program about the pregnancy first
- 2. Ask how it works with prenatal care
- 3. Talk to a prescriber before changing any medicine
About this guide
AI-generated editorial image; it does not depict a real person or event discussed in this guide.
Examples in this guide are illustrative, not reported experiences.
SoberSphere provides independent general information, not individual medical, legal or financial advice. No provider referral, affiliate arrangement or specialist review is claimed.