CARE FOR PREGNANT AND POSTPARTUM PATIENTS WITH SUBSTANCE USE DISORDER
The Care for Pregnant and Postpartum Patients with Substance Use Disorder Patient Safety Bundle was revised in 2021 to incorporate respectful care concepts, revise existing elements, include new elements related to evidence-informed practices, and update data collection tools. The bundle provides actionable steps that can be adapted to a variety of facilities and resource levels to improve quality of care and outcomes for patients with substance use conditions.
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Patient Safety Bundle Documents
Patient Safety Bundle
Element Implementation Details
Implementation Resources
Patient Safety Bundle
Element Implementation Details
Implementation Resources
Data Collection Plan
Change Package
Learning Modules
Data Collection Plan
Change Package
Learning Modules
Data Collection Plan
Change Package
Learning Modules
QUICK LINKS
READINESS
Every Unit
- Provide education to pregnant and postpartum patients related to substance use disorder (SUD), naloxone use, harm reduction strategies, and care of infants with in-utero substance exposure.*
- Develop trauma-informed protocols and training specific to SUDs.
- Provide clinical and non-clinical staff education on optimal care for pregnant and postpartum patients with SUD, including federal, state, and local notification guidelines for infants with in-utero substance exposure and comprehensive family care plan requirements.*
- Engage appropriate partners to assist pregnant and postpartum patients and families in the development of family care plans, starting in the prenatal setting.*
- Establish a multidisciplinary care team to provide coordinated clinical pathways for patients experiencing SUDs.*
- Develop and maintain a set of referral resources and communication pathways between obstetric providers, community-based organizations, and state and public health agencies to enhance services and supports for pregnant and postpartum families for social needs, behavioral health supports, and SUD treatment.*
RECOGNITION & PREVENTION
Every Patient
- Screen all pregnant and postpartum patients for SUDs using validated self-reported screening tools and methodologies during prenatal care and during the delivery admission.*
- Screen each pregnant and postpartum patient for medical and behavioral health needs and provide linkage to community services and resources.*
- Screen for social factors of health that might impact clinical recommendations or treatment plans and provide linkage to resources.
RESPONSE
Every Event
- Assist pregnant and postpartum patients with SUD to receive evidence-based, person-directed SUD treatment that is welcoming and, discuss readiness to start treatment, as well as referral for treatment with warm hand-off and close follow-up.*
- Establish specific prenatal, intrapartum and postpartum care pathways that facilitate coordination among multiple providers during pregnancy and the year that follows.*
REPORTING & SYSTEMS LEARNING
Every Unit
- Identify and monitor data related to SUD treatment and care outcomes with disaggregated data to support analysis.
- Convene inpatient and outpatient providers and community stakeholders to share successful strategies and identify opportunities to improve outcomes and system-level issues.*
RESPECTFUL, SUPPORTIVE & PATIENT-CENTERED CARE
Every Unit/Provider/Team Member
- Engage in open, transparent, and empathetic communication with the pregnant and postpartum patients and their identified support person(s) to understand diagnosis, options, and treatment plans.*
- Integrate pregnant and postpartum patients as part of the multidisciplinary care team to establish trust and ensure informed, shared decision-making that incorporates the pregnant and postpartum patient’s values and goals.*
- Respect the pregnant and postpartum patient’s right of refusal in accordance with their values and goals.*
Additional Resources
Implementation Webinar (Video)
Bundle Element Context and Reference List (xlsx)
Care for Pregnant and Postpartum Patients with Substance Use Disorder REDCap Template
Implementation Webinar (Video)
Bundle Element Context and Reference List (xlsx)
Care for Pregnant and Postpartum Patients with Substance Use Disorder REDCap Template
Additional Languages
Patient Safety Bundle – Spanish (PDF)
Element Implementation Details – Spanish (PDF)
Data Collection Plan – Spanish (PDF)
Patient Safety Bundle – French (PDF)
Element Implementation Details – French (PDF)
Data Collection Plan – French (PDF)
Implementation Resources – French (PDF)
Patient Safety Bundle – Spanish (PDF)
Element Implementation Details – Spanish (PDF)
Data Collection Plan – Spanish (PDF)
Patient Safety Bundle – French (PDF)
Element Implementation Details – French (PDF)
Data Collection Plan – French (PDF)
Implementation Resources – French (PDF)
Patient Safety Bundle Acknowledgements
- This Patient Safety Bundle was originally developed by the Alliance for Innovation on Maternal Health in collaboration with Melinda Campopiano von Klimo, MD; Lisa Cleveland, PhD, RN, IBCLC; Autumn Davidson, MD, MPH; Daisy Goodman, DNP, CNM, WHNP, MPH; Deborah Kilday, MSN, RN; Elizabeth Krans, MD*; Angela Kueck, MD; David Laflamme, PhD, MPH; Lisa Leffert, MD; Elliott Main, MD; Kathy Mitchell; David O’Gurek, MD; Ruth Ann Shephard, MD, MPH; Kimberly Sherman, MPH; Mishka Terplan, MD, MPH*; Nancy K. Young, PhD.
- This patient safety bundle was revised by Lisa Cleveland, PhD, RN, IBCLC; Daisy Goodman DNP, CNM, WHNP, MPH; Elizabeth Krans, MD; Mishka Terplan, MD, MPH; and Dan Weiss, MPH.
- Melinda Campopiano, MD, Autumn Davidson, MD, Robyn D’Oria, MA, RNC, APN, Keisher Highsmith, DrPH, Lisa Leffert, MD, National Birth Equity Collaborative, New Mexico State AIM Team, New York State AIM Team, David O’Gurek, MD, Jessica Taylor Clark (Pt lived experience) and Nancy K. Young PhD reviewed and provided feedback on this document.
© 2025 American College of Obstetricians and Gynecologists. Permission is hereby granted for duplication and distribution of this document, in its entirety and without modification, for solely non-commercial activities that are for educational, quality improvement, and patient safety purposes. All other users require written permission from ACOG.
Standardization of health care processes and reduced variation has been shown to improve outcomes and quality of care. This bundle reflects emerging clinical, scientific, and patient safety advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Although the components of a particular bundle may be adapted to local resources, standardization within an institution is strongly encouraged.