Caitlyn Carnahan was a star patient in her MAT program in Oklahoma City, where she attended regular 12-step meetings and passed every urine test. But when someone from the state’s Department of Human Services arrived to question her in 2019 as she tended to her newborn son in the NICU, Carnahan felt as if all of her accomplishments were erased. The investigator asked why she had used Subutex, a form of buprenorphine, during pregnancy if she knew it could cause withdrawal symptoms, Carnahan told me. The woman also brought up Carnahan’s husband’s extensive record, including three arrests stemming from domestic incidents from when he was still using opioids. She asked Carnahan why she would be with such a person. “I can see where she’s going with this, and it was just terrifying,” Carnahan says. “It was like a scary movie.” Her son was in foster care for eight months.

Carnahan’s doctor had warned her that the hospital might call authorities, but many other women are caught completely by surprise. “I never, not one time, thought about C.P.S. coming to that hospital,” says G.W., who had a baby while taking Subutex in Louisiana in 2019. (G.W. asked to be identified by her initials to protect the privacy of her child.) After her son was removed, G.W. would constantly imagine where he was, what he was doing and mark another day without him on a calendar.

Her lawyer implored her to do whatever the social workers asked. “She would say: ‘Just keep your mouth shut. Just smile and let it go,’” G.W. told me. Caseworkers consider a parent’s cooperation a key factor in determining whether it’s safe to return a child to the home. Parents who aren’t compliant are often viewed as unstable or having poor judgment.

Once a case has been opened, social workers can investigate virtually every aspect of a mother’s life: her housekeeping practices, her income, her romantic partner, the contents of her refrigerator. In South Carolina, Mary DeLancy, whose newborn son was placed into foster care in 2017, recalled being proud to show a caseworker her new apartment, filled with baby toys and stuffed animals, blankets, a bassinet and a bouncy chair — a far cry from the homeless shelter she previously lived in. “It was a huge deal,” she said. “We had worked really hard to get to that point.” But when the caseworker arrived, she pointed out the crib, saying it was outdated and needed to be replaced immediately. DeLancy started to doubt herself. “The more a parent questions ‘Do I deserve my own child?’ the less they try,” she said. “Because they feel like no matter what they do, they’ll never be good enough.”

Even a parent whose newborn is not removed faces a level of surveillance that can be difficult to withstand. “She’s literally 24 hours old — how am I neglecting her?” Blair Morgan-Dota remembers thinking when she was reported for child neglect after giving birth on Subutex. At first the Massachusetts caseworkers let her keep her baby, but when the stress of the case proved too much, and Morgan-Dota relapsed, the agency removed her daughter, and Morgan-Dota resigned herself to failure. “They are making me feel I’m not a good enough mother,” she said. “Maybe she’ll be better with someone else.”