Association of Women’s Health, Obstetric and Neonatal Nurses, Optimizing Outcomes for Women With Substance Use Disorders in Pregnancy and the Postpartum Period, 48 J. Obstet. Gynecol. Neonatal Nurs. 583 (2019).

Study design
Professional Society StatementDefinition: A professional society statement reflects consensus recommendations developed by experts based on research evidence and clinical experience.Evidence quality: These statements sit lower on the evidence pyramid because they rely on expert interpretation rather than new empirical data.Court use: Courts may consider these statements as guidance on professional standards, but they should not be treated as independent scientific proof.Glossary ›
Year
2019

Quote

“The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) opposes laws and other reporting requirements that result in incarceration or other punitive legal actions against women because of a substance use disorder (SUD) in pregnancy and the postpartum period. AWHONN supports universal verbal screening for substance use during pregnancy using a validated tool that should begin at entry into prenatal care and continue periodically throughout pregnancy” (p. 583).

Article primary conclusion

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) issued this 2019 position statement to provide guidance on the care of pregnant and postpartum individuals with substance use disorders (SUDs) and to promote evidence-based, non-punitive approaches to treatment. AWHONN opposes laws and reporting requirements that result in incarceration or other punitive legal actions against pregnant and postpartum individuals with SUDs and supports universal verbal screening using validated tools, early identification of substance use, and access to family-focused, non-stigmatizing treatment.

The statement distinguishes verbal screening from biologic testing and recommends that urine drug testing be performed only with informed consent and in accordance with state laws. It further recommends that patients be informed of the potential consequences of positive test results, including mandatory reporting requirements where applicable. AWHONN emphasizes that the purpose of screening is to identify substance use and facilitate treatment and support rather than to report or punish patients.

More broadly, AWHONN recommends expanding access to community-based treatment, diverting pregnant individuals away from the criminal justice system, and ensuring that healthcare institutions adopt patient-centered policies that prioritize treatment, dignity, and recovery over punishment. The organization also calls for additional research and policies that improve access to evidence-based treatment for pregnant and postpartum individuals with SUDs.

Article context

This statement reflects the position of a major professional organization representing nurses who provide care during pregnancy, childbirth, and the postpartum period. It does not generate new evidence but instead synthesizes existing research into clinical and policy recommendations. The statement is notable for distinguishing universal verbal screening from urine drug testing and for emphasizing treatment, support, and informed consent rather than punitive responses to substance use during pregnancy.

Editor's note

Published in 2019, this statement reflects the emergence of a broad professional consensus regarding substance use during pregnancy. Read alongside subsequent statements from ASAM, ACOG, and SMFM, it demonstrates substantial agreement across nursing, addiction medicine, and obstetric organizations that substance use should be addressed through evidence-based treatment, informed consent, and supportive services rather than punitive or coercive approaches.