Unfortunately, substance abuse is increasing in the patients that we see in labor and delivery. Many women who are abusing drugs are of childbearing age and frequently present first for care in labor. It can then be a challenge to manage them. From caring for them, we have learned much about the drug-addicted patient and how to more completely care for them. The care provided by the whole team must not only be competent but with compassion. We have also learned about our own and our colleagues’ biases and how we can best manage our feelings and theirs as well. The goal of all the clinicians managing these patients has to be excellence in managing their labor physically, clinically, pharmacologically, and psychologically.