Substance abuse and pregnancy: "we have a problem".

A patient is admitted to your OB/triage or OB emergency room at 31 weeks gestation.She has had no prenatal care and appears to be in preterm labor. She admits to illicit drug use (cocaine, methadone, and marijuana) and also selling opioids to maintain her habits.The patient desires "help" in getting off drugs to "help my baby." She says the father of the baby, who stepped out of the room for a smoke, does not know anything about her drug history and asks the admitting nurse to please not tell him. She is worried that the baby maybe taken from her after delivery and could be also abnormal. On examination, she is tearful, drowsy, and tremulous. The fetus is alive and reactive but the she says it has not been moving much. The patient seems to be somewhat evasive in providing additional information, but does admit that she has been for several years positive for hepatitis C. Uterine contractions are every 5 to 6 minutes. A urine drug screen is positive for opioids, benzodiazepines, and cocaine metabolites. The nurse notices that there is a half pack of cigarettes in her purse.What do you and your staff do? What are the patient's options for care and management?What issues are there in caring for this patient and her fetus and eventually her newborn?