Neonatal abstinence syndrome (NAS) is a set of drug withdrawal symptoms that affect the central nervous, gastrointestinal, and respiratory systems in the newborn when separated from the placenta at birth. Maternal substance use of opioids, benzodiazepines, barbiturates, and alcohol can cause NAS. Universal drug screening via questioning pregnant women is recommended, but identification of drug use is incomplete with this method. This article provides resources for the identification and management of drug use during pregnancy for midwives who provide care not only during the prenatal period but also during the intrapartum and postpartum periods. The impact of drug use on newborns can be significant and may require pharmacologic assistance with the transition to extrauterine life. Challenges involved in caring for the woman who is using drugs during pregnancy include ordering toxicology screens on the newborn, alerting social services, and educating the woman about her newborn's progress. Several measures to comfort a newborn with NAS may help to enable a mother to provide the best care for her newborn.