Written by Elizabeth Cairns, Mobilize Recovery Special Projects, and reviewed by Code Recover Peer Advisors, August 2026

In the Emergency Department, encountering a pregnant individual navigating substance use is a high-stakes moment—medically, emotionally, and systemically. Perinatal Substance Use Disorder (PSUD) refers to substance use that occurs during pregnancy and up to one year postpartum. It is crucial to remember that PSUD is a complex medical and behavioral health condition, not a moral failing. These individuals may already be seeking help or engaged in care, and recovery during pregnancy is entirely possible and improves outcomes for both the parent and the baby.

Many pregnant patients with OUD are overwhelmed by severe, specific fears:

• Fear of losing custody of their baby.
• Fear of judgment or punishment from medical staff.
• Fear that withdrawal will harm their pregnancy.
• General confusion about what will happen to them next.

Your role as a peer is not clinical, but relational; your presence might be the very first moment of safety they feel in the healthcare system.

The 3-Minute Engagement Structure

Because ED environments are fast-paced, you often have limited time to build trust. When time is tight, rely on this three-step structure:

• Connect: Introduce yourself clearly and simply. Example: "I'm here to support you. I'm in recovery myself."
• Normalize: Acknowledge their fear without trying to fix it. Example: "A lot of people feel scared in this situation."
• Offer: Ask permission before engaging and use choice-based language. Example: "What would feel most helpful right now?" If they are disengaged, simply offer to sit with them.

Always assume trauma is present and use a trauma-informed approach characterized by choice, collaboration, and empowerment. Avoid control, pressure, or directive language. Use calm, grounded body language and sit at eye level when possible.

Explaining "What Happens Next" and Plans of Safe Care

Patients are often in the dark about the hospital process. You can reduce anxiety by explaining that the medical team will check the health of both the patient and the baby, providers will discuss substance use and care options, and support services will be introduced. After this, follow-up care and resources are offered.

Often, a "Plan of Safe Care" will be created. This is highly misunderstood and feared by patients. Explain that it is a coordinated support plan focused on safety, health, and connection to services—not automatically a child removal action. (source)

Peer Framing: "It's meant to support you and your baby, not punish you."

Discussing MOUD/MAT/MAR

Medication for Opioid Use Disorder (MOUD), Medication Assisted Treatment (MAT), or Medication Assisted Recovery (MAR) all refer to utilizing medications like methadone and buprenorphine to treat substance use disorder, and it is the standard of care during pregnancy for OUD. (source)

• MAT is safe and recommended during pregnancy.
• It stabilizes both the parent and the baby.
• It reduces the risk of overdose, preterm birth, and other complications. (source)
• Medically supervised care is safer than going through withdrawal without support.

Peer Framing: "There are medications that help stabilize your body safely during pregnancy. Many people use them and go on to have healthy pregnancies."

Answering the Hardest Question: "Are They Going to Take My Baby?"

This question requires absolute honesty and care; you must avoid false reassurance or avoidance.

Response: "I hear how scary that is. Every situation is different, but getting support and staying engaged in care is one of the strongest things you can do right now."

Be honest about your limits, explaining that while you can't control every part of the system, you can help them understand what is happening.

Boundaries and the Warm Handoff

In crisis moments, stay calm, match the patient's pace, use their name, and keep language simple. Do not over-explain, try to convince them, speak outside of your role, or defend the hospital system.

You must elevate the situation to clinical staff immediately if there are suicidal thoughts expressed, medical distress is present, severe withdrawal symptoms occur, or there are safety concerns like domestic violence.

When it is time for the patient to transition, do not leave them without a clear next step. Ensure they know who is next in their care, provide a connection point (like a name or service), and introduce them directly when possible.

Grounding Reminder for Peers: Success is not immediate behavior change; success is the patient feeling safe, staying engaged in the moment, and being open to next steps. You are not responsible for fixing everything. In this moment, connection matters more than outcomes. Connection is what keeps both the parent and baby safer.