How should a clinician respond to a client disclosing substance use during pregnancy?

• A. Dismiss the disclosure and continue as usual.
• B. Follow mandatory reporting and safety planning; provide nonjudgmental support; refer to specialized services; ensure patient safety; discuss treatment options.
• C. Punish the client or threaten with withdrawal of services.
• D. Immediately terminate care.

Answer: (B)

When a client discloses substance use during pregnancy, the priority is a supportive, safety-focused response that connects the patient to appropriate care while following legal obligations. The best approach starts with an empathetic, nonjudgmental acknowledgment of the disclosure, which helps maintain trust and encourage ongoing engagement in treatment and prenatal care. Clinicians should assess risk to both mother and fetus and work with the client to develop a safety plan that addresses immediate concerns, such as withdrawal risks, overdose, or unsafe behaviors.

Equally important is providing information about treatment options and making referrals to specialized services (e.g., perinatal addiction treatment, counseling, and coordinated care with obstetrics). The clinician should discuss options in a collaborative way, respecting the patient’s autonomy and readiness, and help navigate barriers to access. Confidentiality matters, but it has limits; in jurisdictions with mandatory reporting or child protective service requirements, the clinician must explain what must be reported and why, while focusing on safety and support, not punishment.

Responses that dismiss the disclosure, threaten withdrawal of services, or terminate care undermine trust and safety, and do not promote outcomes for mother or baby. The aim is to protect safety, reduce harm, and keep the patient engaged in care through compassionate guidance and appropriate referrals.