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Physician’s Weekly spoke with Dr. Leah Habersham about interventions for pregnant patients affected by substance use and ways OB/GYNs can better support them.

Obstetricians and gynecologists are tasked with delivering quality care to pregnant people affected by substance use, yet seldom receive sufficient training on how to do so. To address this gap, Leah L. Habersham, MD, MBA, and colleagues conducted an expert review that provided a comprehensive overview of substance use during the prenatal and postpartum periods.

“A family-centered prevention plan designed to outline and promote the safety and wellbeing of birthing parents and their infants is required for all with prenatal substance exposure,” Dr. Habersham and colleagues wrote in the American Journal of Obstetrics and Gynecology.

The researchers advocated that OB/GYNs are in a good position to screen for substance abuse and coordinate plans of safe care. They also emphasized that OB/GYNs can help pregnant people access live-saving harm reduction treatments, like medications to reduce cravings when abstinence is unattainable. OB/GYNs should deliver care in a way that eradicates the stigma, fostering environments of care that center on the mother and family, they noted.

Yet the burden of substance abuse interventions for pregnant populations doesn’t fall on OB/GYNs alone. These providers can, and should, intentionally collaborate with other clinicians. “Given the multifaceted nature of [substance use disorder], a pregnant patient will require a range of services including substance use treatment, psychiatric care, social support, and possibly specialized neonatal care,” Dr. Habersham and colleagues wrote. “OBGYNs often facilitate such care coordination to optimize both maternal and fetal outcomes.”

Physician’s Weekly (PW) spoke with Dr. Habersham about practical ways OB/GYNs can screen for care and effectively coordinate care when necessary.

PW: How does implementing a plan of safe care change/enhance the way OB/GYNs provide treatment?

Leah L. Habersham, MD, MBA: A Plan of Safe Care (POSC) is a federally mandated requirement for pregnancies complicated by substance use disorders, intended to ensure the safety and well-being of both mother and baby. When used effectively, a POSC can inform and standardize care approaches for this population. However, it’s crucial for providers to recognize that if misused or weaponized, a POSC can also cause harm and erode trust.

That said, when implemented thoughtfully, a POSC enhances care coordination and promotes a standardized approach to treatment. It acts almost like a checklist, helping providers focus on key areas of concern and ensuring all members of the care team remain aligned in their approach.

How can busy OB/GYNs find the time to address substance use in pregnancy?

OB/GYNs are already screening patients during initial prenatal visits. We routinely ask about substance use, nicotine, and alcohol. The key is to standardize this process by using validated screening tools. Providers may also be surprised to learn that asking these questions can be billable through many insurers, creating incentives for both individual providers and health systems.

A major barrier to screening is the fear of not knowing what to do when a patient screens positive. This is why identifying local resources in advance is so important. Having a referral network and contact information on hand can make the process smoother, more efficient, and far less daunting.

What advice would you give OB/GYNs looking to implement a plan of safe care?

I recommend starting with existing templates, such as the one provided by the New York State Department of Health, and then tailoring the POSC to your own patient population and clinical setting.

Collaboration is essential. Involve your broader care team: Social workers, case managers, addiction specialists, and neonatal providers all have critical roles to play in crafting a plan that truly works. A well-coordinated, team-based POSC can dramatically improve outcomes for families.

You discussed the need to provide care without stigma. How can OB/GYNs accomplish this?

Reducing stigma starts with intentionality. Words matter—how we talk about substance use can reinforce or reduce stigma. We can also adopt trauma-informed, harm-reduction approaches that center the patient’s experience and autonomy. This includes creating a safe space for disclosure, responding non-judgmentally, and recognizing that many patients fear the involvement of child protective services. Being knowledgeable and up to date on these topics allows us to provide informed, compassionate care that builds trust rather than fear.

What excites you about OB/GYNs playing a role in a plan of safe care and increasing awareness about supporting these patients?

This is an opportunity to actively support and empower our patients. OB/GYNs are natural advocates for women’s health, and engaging in POSC coordination is a powerful way to extend that advocacy to one of the most vulnerable populations we serve.

By being informed and intentional, we can shift trajectories—improving maternal recovery outcomes, strengthening the parent-child bond, and contributing to healthier futures for families. A little effort from each of us can have a profound impact.