Part 2: Clinical Realities—Diagnosis, Treatment, and Compassionate Care
Series: More Than One Life: Navigating Substance Use Disorder in Pregnancy
🧭 Introduction: Why Diagnosis and Compassion Must Go Together
Healthcare is often viewed through the lens of protocols, labs, and procedures. But for many Black and Brown women, it is also a place of judgment, dismissal, and danger. In these clinical spaces, survival doesn’t just depend on correct diagnoses or timely medications—it depends on whether providers are willing to see their patients as full, complex human beings.
Amanda’s story illustrates this truth. When she stepped into prenatal care, she brought not only the anticipation of motherhood but also the weight of substance use disorder (SUD) and the stigma that comes with it. Too often, patients like Amanda are criminalized or ignored. But her story unfolded differently—because her care team chose compassion. They treated her not just as a diagnosis, but as a person. That decision made all the difference.
This article explores how clinical excellence must be paired with justice, empathy, and equity. Through Amanda’s experience, and the broader evidence on SUD in pregnancy, we’ll examine how a care model rooted in humanity can change lives—and why it’s urgently needed for those most marginalized by our healthcare system.
Let’s break down the facts, dispel the myths, and reimagine what’s possible when clinical rigor meets radical compassion.
Diagnosis: Clarity with Compassion
Compassionate care is vital, but so is an accurate diagnosis. In clinical practice, precision matters. Providers rely on established guidelines from leading organizations like the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). These frameworks are essential—they bring consistency and evidence-based standards to complex cases. For mental health and substance use, clinicians use the DSM-5-TR to categorize symptoms and determine diagnoses. These tools are meant to clarify, not to constrain; they offer a roadmap for identifying needs and tailoring care.
But the act of diagnosis is not simply technical—it is relational. A diagnosis can open the door to support, or it can slam the door shut. When we assess symptoms in a vacuum, without understanding a patient's full story, we risk creating harm. In Amanda’s case, understanding the physiological and emotional nuances of opioid use in pregnancy—combined with deep listening—helped her providers deliver informed, individualized care. They didn’t rely solely on lab results or intake forms. They paused. They asked questions. They created space.
Misdiagnosis, delayed diagnosis, or premature judgment are more than clinical errors—they’re violations of trust. For marginalized patients, especially those with complex health histories or intersecting challenges like poverty, trauma, or incarceration, diagnostic encounters can feel like interrogations. When providers focus only on symptoms without context, they miss the forest for the trees.
We must also acknowledge that diagnostic criteria are often developed and validated in populations that don’t reflect the diversity of real patients. Cultural bias, language barriers, and systemic racism shape how symptoms are interpreted—and whether they’re believed. A justice-driven diagnostic process involves transparency, collaboration, and humility. It is about asking: What else might be going on? What assumptions am I bringing into this room?
💡 Action Points for Providers
✅ Use validated tools like the DSM-5-TR, T-ACE, and 4P’s Plus, but contextualize results within each patient’s story.
✅ Normalize screening by making it routine, not punitive.
✅ Prioritize cultural humility and consider how historical trauma may shape patient presentation.
✅ Make diagnosis a conversation—not a verdict.
✅ Avoid labels and deficit language. Say "experiencing SUD," not "addict."
Treatment: Centering Whole-Person Healing
Once a diagnosis is made, what comes next is equally critical: treatment. But treatment is not a one-size-fits-all algorithm. It must be holistic, responsive, and sustainable. In the case of substance use disorder (SUD) during pregnancy, this means understanding that addiction is not a moral failure—it is a complex health condition, deeply shaped by social and structural determinants.
Validated screening tools like T-ACE, 4P’s Plus, and SBIRT help build bridges, not walls. They invite honesty and trust, especially when paired with nonjudgmental, empathetic conversation. These tools are more effective when providers communicate safety and respect in every step.
Medication-Assisted Treatment (MAT) is the gold standard for managing opioid use in pregnancy. Buprenorphine and methadone are both safe and effective when used properly, reducing withdrawal risks and neonatal complications. Still, medication alone isn’t enough. MAT is most successful when embedded in comprehensive care that includes housing support, transportation, mental health counseling, social services, and culturally affirming relationships.
Amanda’s story illustrates this perfectly. She succeeded not just because she took the right medication, but because her care team supported every part of her life. They listened. They helped her secure resources. They ensured continuity of care. This wrap-around approach enabled Amanda to move from survival to thriving.
Too often, healthcare systems expect patients to navigate labyrinthine systems while burdened by stigma, poverty, and untreated trauma. The burden must shift. It is our responsibility to create treatment environments that foster dignity and meet patients where they are—not where we think they should be.
💡 Action Points for Providers
✅ Prioritize MAT with buprenorphine or methadone during pregnancy; both are compatible with breastfeeding.
✅ Build multidisciplinary teams that include OBs, addiction specialists, social workers, and mental health professionals.
✅ Provide same-week postpartum follow-up to reduce overdose risk and increase treatment retention.
✅ Consider barriers to access: transportation, childcare, and stigma must be addressed as part of the care plan.
✅ Create care plans that emphasize agency, shared decision-making, and long-term support.
Compassionate Care: A Justice-Driven Imperative
Compassion is not a soft add-on to medical care. It is a clinical imperative—especially for marginalized patients who have been repeatedly harmed by the healthcare system. Compassion shapes whether patients return to care, disclose critical concerns, and ultimately survive the perinatal journey.
Amanda came into care wary and guarded—rightfully so. But her care team centered dignity from the start. They did not reduce her to risk factors or compliance metrics. They offered presence, respect, and safety. This mattered. Through MAT, trauma-informed counseling, consistent follow-up, and community support, Amanda didn’t just give birth to a healthy baby—she reclaimed control over her health and her story.
Compassionate care affirms: You are more than a diagnosis. You deserve to be heard. Your life and your choices matter. It recognizes that trauma, racism, poverty, and stigma are not personal failings; they are systemic realities. And it responds with rigor, empathy, and a commitment to justice.
💡 Action Points for Providers
✅ Greet each patient with respect, regardless of their background or medical history.
✅ Listen deeply before offering advice. Build trust before you build a treatment plan.
✅ Train your team in trauma-informed care, implicit bias, and cultural humility.
✅ Acknowledge the patient’s expertise in their own life. Collaborate—don’t dictate.
✅ Frame every clinical interaction as an opportunity to affirm dignity, not reinforce hierarchy.
⚖️ Reproductive Justice: The Bigger Picture
Clinical encounters are never just about the body—they’re about power. And for Black and Brown women, that power has long been stripped away by a system that punishes rather than supports.
Reproductive justice isn’t just a framework. It’s a demand: that every person has the right to have a child, not have a child, and to parent in safe, supportive environments. That includes safe, non-punitive care during pregnancy and postpartum—even (and especially) when substance use is involved.
Amanda’s story didn’t end in family separation or incarceration. But for many others, it does. Twenty-six states currently mandate child protective service reports for prenatal drug exposure. Black women are more likely to be tested without consent, more likely to have their children removed, and less likely to be offered treatment.
This is not just a public health issue—it’s a civil rights crisis.
Justice-driven care must go beyond the clinic. This means:
Repealing policies that criminalize pregnancy.
Protecting patient privacy and informed consent.
Centering the voices and expertise of patients in their own care.
Funding culturally specific and community-led care models.
When we practice through the lens of reproductive justice, we stop asking, “What’s best for the baby?” and start asking, “What’s best for this person, in this moment, in their full humanity?”
Only then can we create a system worthy of trust.
🛠️ Real-World Steps Providers Can Take Today
If you’re a provider, policymaker, or health leader wondering, "What can I do?"—start here. Clinical excellence isn’t just about what you know. It’s about how you show up. Here’s how to make compassionate, evidence-based care a reality—especially for patients like Amanda.
👂🏾 Screen With Empathy
Use 4P’s Plus or SBIRT, but frame questions with warmth and openness.
Avoid punitive language. Say, "Tell me about your relationship with substances," not "Do you use drugs?"
💊 Prescribe Evidence-Based Treatment
Refer to OBs who can prescribe buprenorphine.
Ensure patients know MAT is safe in pregnancy and compatible with breastfeeding.
🌍 Build Systems That Actually Support Patients
Create or refer to multidisciplinary teams that include doulas, social workers, addiction medicine, and mental health.
Offer flexible visit scheduling and address transportation and childcare barriers.
🧠 Shift the Narrative
Challenge punitive policies in your clinic or hospital.
Speak out against mandatory reporting laws that deter care.
Educate colleagues: Compassion is not weakness—it’s clinical excellence.
🤝 Partner, Don’t Police
Use person-first language (“person with SUD,” not “addict”).
Ask: "What matters most to you right now?" and build the plan around that.
Center patients as decision-makers in their care—not just recipients of it.
When we lead with dignity, we don’t just improve outcomes. We transform lives.
🔄 Closing Thoughts & What’s Next
Amanda’s story reminds us that every clinical decision is also a moral one. When we meet patients with clarity and compassion, we don’t just provide treatment—we affirm their worth. But Amanda is not alone.
In our next issue, we’ll meet Keisha, a pregnant woman navigating both substance use and anxiety. Her story reveals how deeply mental health, trauma, and structural racism are intertwined—and why we must approach care as both a clinical and community responsibility.
Don’t miss it. We’ll explore trauma-informed strategies, policy reforms, and real-life examples of what it looks like when healthcare systems lead with healing instead of punishment.
👉🏾 Subscribe, share, and keep the conversation going. Because more than one life is always at stake.