At my place we do a UDS on any mom who has no prenatal care, limited prenatal care (< 3 visits), comes in abrupting, or a history of illicit drugs and/or narcotic use during the pregnancy. That casts a pretty wide net, admittedly, and most of the time the screens come back negative. Anybody with a positive UDS or hx substance use gets a social work consult as well.
For babies, we do a UDS if mom had no or limited prenatal care, if mom's UDS comes back +, or if mom admits to using (even if her UDS on admit is negative). I have seen babies come back + when mom is negative.
Any baby whose mom took narcotics (and sometimes even SSRIs) regularly during pregnancy gets abstinence scores with feedings, and we start q4h morphine (0.05 mg/kg) for 3 consecutive scores above 8. If scores are still consistently bad and/or baby has marked tremors, we start daily phenobarb too. According to the scores the peds titrate the dose up or down and wean accordingly. One thing to keep in mind is that babies can seize and possibly die from untreated withdrawal, so next time around whoever is taking care of the baby needs to not sit on those symptoms. (Not casting blame on you
...just making a general statement.)
When a baby comes in that we suspect may start withdrawing our NPs are really really good about educating their parents about what we're doing and why. They let them know up front that the baby may not be going home with them upon Mom's discharge. However, most babies do get discharged home with parents once they are weaned off the morphine. We encourage Mom to breastfeed/pump if she wants to, as it's not contraindicated and most babies' scores are much better if they're getting her breastmilk. In any case, they can come and visit anytime they want after Mom's discharged from the hospital.
It can be a tricky situation. If your place isn't equipped to care for withdrawing babies - it can be a challenge - you may need to push for a transfer to a bigger hospital. Not
saying that you or your facility are incapable, just that it's not a fair thing to ask of a small facility that may not have the staff/resources to deal with this.
Interesting article: http://emedicine.medscape.com/article/978763-overview