This chapter examines the use of drugs—both legal and illegal–by pregnant women, noting increased medical and legal supervision of pregnancy and women’s substance use and abuse. Many states require health care professionals to report pregnant women who admit to, or are suspected of, using alcohol or other drugs. The result can be involuntary detention commitment for “treatment.” Women have been prosecuted for homicide after they suffer a stillbirth despite weak evidence that the stillbirth was caused by drug use. Prosecution of these women is counterproductive, because it drives pregnant drug users underground, away from both prenatal care and drug treatment.