If you are pregnant or just had a baby and you’ve been using substances—whether alcohol, other drugs, or prescription medications, you may feel scared and wonder: “Will my baby be taken away if I’m using substances?” “What if I tell my doctor or another healthcare provider that I’ve been drinking or using other drugs?” “Or what if I test positive for substances?” These are common and serious concerns. The truth is: it depends on where you live, your situation, and whether you are getting help.

It’s important to know that in some states the use of substances during pregnancy is considered to be child abuse. Further, substance use is the most common reason for reporting to Child Protective Services (CPS).

This article is for educational purposes only. Partnership to End Addiction does not necessarily endorse or support the policies and actions of Child Protective Services across different states.

Every State Is Different

Child Protective Services rules are different in every state. Some states require doctors or hospitals to report any positive drug test during pregnancy or at birth. In other states, it depends on whether the substance use is harming the baby or if there are signs of neglect. Neglect can include lack of enough food, housing, clothing and healthcare as well as ignoring the baby or not providing enough stimulation.¹

For example, as of June 2024: ²

Prenatal substance use is considered child abuse or neglect in 24 states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Massachusetts, Michigan, Minnesota, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, and Wisconsin and the District of Columbia

Substance use alone is not considered child abuse or neglect – more information is needed in 14 states: California, Delaware, Kentucky, Maine, Maryland, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Oregon, Pennsylvania, and Wyoming.

12 states do not include substance use during pregnancy in their child abuse or neglect laws: Alaska, Connecticut, Hawaii, Idaho, Mississippi, Nebraska, New York, North Carolina, Rhode Island, Vermont, Washington, and West Virginia), Guam, Puerto Rico, and the U.S. Virgin Islands

What Happens If a Drug Test Is Positive at Birth?

If your lab work or your baby’s test comes back positive for substances, the hospital might contact CPS or the child welfare agency. CPS is responsible for ensuring the baby is safe. They may investigate and determine that there is no problem. In other cases, they may remove the baby from the home because they do not consider the home to be a safe place. Or they may decide that the baby can stay in home as long as their recommendations are followed.

Regardless of the decision, any investigation by CPS is scary for most people. It may help to have some information on what likely happens next.

An investigation usually includes:

Interviewing you – A CPS worker will talk with you about your substance use, medical care, and how you plan to take care of your baby.
Visiting your home—They may visit your home to check if it’s safe, clean, and has what a baby needs (like a crib, food, and electricity).
Talking to others – CPS might speak with your doctor, family members, or other people who help care for your baby.
Looking at your history – They’ll check if you’ve had other CPS cases or legal problems involving children.
Making a decision – Based on what they learn, they might:
- - Close the case if they see no serious risk.
  - Offer services to help you (like parenting classes, treatment, or home visits).
  - Create a Plan of Safe Care so you can keep your baby while working on recovery.
  - Place the baby with a trusted family member or in foster care if they think the baby is in danger.
There are many factors that can affect the likelihood of being reported and what someone’s experience with the child welfare system will be like. For example, infants born exposed to substances may be more likely to be placed in foster care. One study found that 1 in 3 children who were exposed to substances during pregnancy were placed in foster care. Families experiencing poverty are also more likely to be reported to the child welfare system, despite no evidence showing a higher rate of neglect (Raz et al., 2021).

It’s important to note that non-white families are likely to face more problems than white families. Numerous research studies have shown that compared to White families, Black families are:

More likely to be reported for suspected poor treatment of their child (Miller, 2008; Putnam-Hornstein et al 2013)
More likely to have allegations or concerns lead to an investigation (Fluke et al., 2003; Harris & Hackett, 2008)
More likely to have an investigation lead to consequences including being removed from the home and placed in foster care (Detlaff et al., 2011; Font et al., 2012; Putnam-Hornstein et al., 2013; Maguire-Jack et al., 2020; Witcraft et al., 2024)
More likely to have several different placements in foster care and take longer to be reunited with their child (Miller, 2008; Huggins-Hoyt et al., 2019)
Less likely that the child will be reunited with their parent(s) at all (Miller, 2008; Huggins-Hoyt et al., 2019; Witcraft et al., 2024).

What Can I Do to Protect My Baby?

It can be a frightening to think that you could be at risk of losing your baby, especially if you are a Black woman. But there are steps you can take to protect your baby.

If you’re using substances or struggling with your mental health, getting help now is one of the best things you can do for your baby. It shows you care and want to keep your baby safe. Child Protective Services (CPS) often looks at whether a parent is willing to take steps to get better. Going to treatment, staying in the program, and keeping records of your progress can help show you’re taking this seriously.

Follow medical advice

Make sure to go to all your doctor appointments, both during pregnancy and after your baby is born. This helps keep both you and your baby healthy. When CPS sees that you’re going to appointments and following your doctor’s advice, it shows that you’re doing your part to take care of your baby.

Create a Plan of Safe Care:

A Plan of Safe Care is a plan that helps you and your baby get the support you need—like medical care, parenting help, or treatment for substance use.

States are required to develop and monitor a Plan of Safe Care (POSC) for infants and families affected by substance use or withdrawal symptoms during pregnancy.³ The Plan of Safe Care is a written plan that helps you and your baby stay safe and healthy. It lists the support you’ll get and the steps you’ll take to meet your baby’s needs. Having this plan in place shows you are working to give your baby a safe and stable home. You can ask your hospital or CPS worker to help you make one.

Here is a sample Plan of Safe Care:

Parent Name: Maria R.
Baby Name: Baby R. (due 5/30)
Created By: Hospital social worker and CPS caseworker
Date: 5/20

Medical Care
✅ Maria will attend all OB appointments and all baby checkups.
✅ Baby R. will be seen by the pediatrician 48 hours after discharge.
✅ Maria will take any prescribed medications as directed.
Substance Use Treatment
✅ Maria is enrolled in the New Hope Recovery Program.
✅ She will attend outpatient treatment 3 times a week.
✅ She will continue working with her substance use counselor, Ms. Lee.
Mental Health Support
✅ Maria will attend weekly therapy sessions for depression and anxiety.
✅ She will work with a case manager for medication management.
Parenting Support
✅ Maria will attend a parenting class for new moms, starting June 5.
✅ Maria’s mother will help care for the baby when Maria attends treatment.
Safe Living Environment
✅ Maria and the baby will live with Maria’s mother in a safe, stable home.
✅ Home has working utilities, food, and a crib for the baby.
Emergency Plan
✅ If Maria feels overwhelmed or has cravings, she will call her sponsor or treatment center.
✅ If an emergency happens, Maria’s mother will care for Baby R. and call CPS if needed.

Signatures:
✔ Maria R.
✔ CPS Worker
✔ Hospital Social Worker
✔ Treatment Counselor

Who Can I Turn to for Help?

Many people can help you find treatment and support, including your OBGYN and midwives. You may wish to ask around though to see who offers recovery-friendly services. Some treatment centers offer services specifically for moms and pregnant women. A peer recovery coach who has had similar challenges may be an option as they can provide support and guidance having “been there.”

In terms of your rights, you can reach out to legal aid services in your community. They can explain what the law says in your state about substance use during pregnancy. They’ll let you know what CPS, the hospital, or the court is allowed (and not allowed) to do. If there’s a court case or CPS is involved, a legal aid attorney can speak on your behalf. They can argue for your right to stay with your baby, especially if you’re getting treatment and creating a safe plan.

At Partnership, our Baby Steps Helpline offers support for moms dealing with substance use in pregnancy and postpartum, so please reach out for confidential support in English and Spanish. Our helpline specialists will listen to your concerns, provide guidance and direct you to other resources. You don’t have to do this alone!

Some other resources include:

MotherToBaby – They offer a great deal of information on the benefit or risk of medications and other exposures during pregnancy and while breastfeeding.

Safe Locator – Safe Locator is a search tool you can use to find treatment programs that specialize in helping pregnant women.

Pregnancy Justice – This organization defends people who face investigation, arrest, or detainment related to any pregnancy outcome or were forced to have a surgery because of pregnancy.

If you’re worried about your baby being taken away, know this: You have options, and you are not alone. A positive drug test doesn’t automatically mean you’ll lose your baby. Getting help, creating a plan, and being open with your care team can make a big difference.