Oregon Integrates Addiction Treatment Into Pregnancy Care as Maternal Deaths Rise

Pregnancy should be a time of focused medical attention and planning for the future. But for thousands of women managing substance use disorders, that critical period has instead become one of the most dangerous in their lives.

In Oregon, state data delivered a stark reality check: between 2018 and 2021, mental health conditions and substance use disorder were the leading causes of pregnancy-related deaths. At the same time, an Oregon Health & Science University study documented that opioid use during pregnancy has more than doubled over the past decade. The confluence of rising substance use and maternal mortality has pushed Oregon to rethink how it delivers care to one of its most vulnerable populations.

The answer, according to health officials and advocates across the state, lies in integration—not separation. Programs like Project Nurture and Nurture Oregon are abandoning the traditional model that shuttles pregnant women between disconnected systems. Instead, they're embedding addiction treatment directly into prenatal care, surrounding patients with peer support, social services, and medical expertise under one coordinated umbrella.

The gap between need and care

Pregnant women with substance use disorders face a double bind. Many avoid prenatal care entirely, fearing judgment, legal consequences, or loss of custody. Those who do seek help often find that drug treatment centers turn them away, citing potential health risks or lack of specialized staff.

The result is a care vacuum at precisely the moment when both mother and child are most at risk. Untreated opioid use disorder during pregnancy increases the likelihood of complications including preterm birth, low birth weight, and neonatal abstinence syndrome. For the mother, the risks extend beyond delivery: overdose deaths among new mothers have risen sharply nationwide, with many occurring in the weeks and months after childbirth when medical supervision tapers off.

Oregon's maternal mortality data underscored this crisis. Mental health and substance use disorder weren't minor contributors—they were the primary drivers of pregnancy-related deaths over a four-year span. That finding, combined with the OHSU study showing opioid use rates doubling during pregnancy, made clear that incremental adjustments wouldn't be enough.

Project Nurture: embedding treatment in maternity care

Project Nurture, operating through Legacy Health and originally developed by Health Share of Oregon, takes a radically different approach. Rather than referring pregnant women to separate addiction services, the program integrates substance use treatment directly into maternity care. Women enrolled in Project Nurture receive prenatal visits, addiction treatment, inpatient maternity care, postpartum support, and pediatric care for their infants—all coordinated through a single team.

The model recognizes that asking a woman struggling with addiction to navigate multiple disconnected systems is a recipe for dropout. By consolidating care, Project Nurture reduces the friction that often leads pregnant women to disengage. Patients meet regularly with obstetricians, addiction specialists, and social workers who communicate with one another, adjusting treatment plans in real time as circumstances change.

For women with opioid use disorder, that often means access to medications for opioid use disorder—buprenorphine or methadone—prescribed alongside standard prenatal vitamins and monitoring. The program also connects patients with housing assistance, job training, and legal support, addressing the social determinants that can derail recovery even when clinical treatment is working.

Diana Smith, the clinical lead for Project Nurture at Legacy Health, emphasized the importance of simultaneous care in a recent Oregon Public Broadcasting interview. "When you're treating substance use disorder during pregnancy, you can't separate the addiction from the pregnancy," she said. "They're interconnected, and the care has to be, too."

Peer support as the bridge

While clinical integration addresses the logistical barriers, stigma remains one of the most persistent obstacles. Many women report feeling judged or shamed during prenatal visits, particularly in emergency departments or when delivering at hospitals unfamiliar with substance use disorder. That stigma can discourage women from disclosing their drug use, leading to missed opportunities for intervention.

Nurture Oregon, a statewide peer support program, addresses this gap by pairing pregnant women and new mothers with trained perinatal peer mentors—individuals who have navigated pregnancy and substance use disorder themselves. These mentors provide emotional support, help clients access resources, and accompany them to medical appointments when needed.

Sarah Bovee, a perinatal peer mentor and doula with Project Nurture, described her role as being a consistent, nonjudgmental presence. "A lot of the women I work with have been told they're bad mothers before their baby is even born," she said. "My job is to remind them that they're doing hard work, that recovery is possible, and that they deserve support."

Peer mentors also serve as cultural interpreters, helping medical staff understand the lived experience of addiction and guiding patients through systems that can feel hostile or overwhelming. Research has shown that peer support improves treatment engagement, reduces relapse rates, and increases the likelihood that women will stay connected to care after delivery.

Evidence and early outcomes

Project Nurture isn't just a hopeful experiment—it has published outcomes. A 2020 study in the American Journal of Obstetrics & Gynecology found that women enrolled in the program were more likely to receive prenatal care, initiate medications for opioid use disorder, and attend postpartum follow-up visits compared with those receiving standard care. Infants born to mothers in the program also had better outcomes, including reduced rates of neonatal abstinence syndrome and fewer child welfare referrals.

The program's success has drawn attention from other states grappling with similar crises. Colorado, Pennsylvania, and Massachusetts have all launched pilot programs modeled on Project Nurture, adapting the framework to local Medicaid structures and treatment networks.

Oregon has also expanded access. What began as a small pilot in Portland has grown to serve multiple counties, supported by Medicaid reimbursement and grants from the state health authority. Nurture Oregon, the peer support arm, now operates statewide, training mentors and connecting them with pregnant women through hospitals, clinics, and community organizations.

Looking ahead

The convergence of rising opioid use during pregnancy and maternal mortality driven by substance use disorder represents one of the most urgent public health challenges facing states today. Oregon's response—integrating addiction treatment into maternity care and embedding peer support throughout the continuum—offers a blueprint that other jurisdictions are beginning to follow.

But scaling these programs will require sustained investment, changes to Medicaid reimbursement policies, and a broader cultural shift in how medical systems treat women with substance use disorders. Pregnant women need more than episodic interventions; they need comprehensive, coordinated care that doesn't end at delivery.

For Oregon, the data made the stakes clear. Now the state is testing whether integrated care can reverse a troubling trend—and whether other states will follow its lead.