In 2016 and 2017, mental health conditions, including substance use disorder, were the leading causes of pregnancy-related deaths in the state. The Illinois Perinatal Quality Collaborative (ILPQC) launched the Mothers and Newborns affected by Opioids – Obstetric (MNO-OB) Initiative in May 2018 based on AIM’s Obstetric Care for Women with Opioid Use Disorder (OUD) patient safety bundle with all 101 of the state’s birthing facilities. Over the course of the initiative, the percentage of sampled pregnant patient records with documentation of a validated screening tool used on Labor & Delivery increased from 3% in Q4 of 2017 to 85% in Q4 of 2020. During the same period, the percentage of patients with OUD who were connected to medication for opioid use disorder by delivery discharge and linked to recovery treatment services increased from 41% to 76% and 48% to 70%, respectively, and the percentage of patients with OUD who received Narcan counseling increased from 2% to 63%. The MNO-OB sustainability phase began in January 2021, where participating facilities worked to track compliance and develop plans for missed quality improvement opportunities. ILPQC continues to support the implementation of strategies for continuing quality improvement, new hire education, and the maintenance of up-to-date maps of community resources.