The paper is divided into four parts. Part 1 reviews the historical rights of the fetus in relationship to the rights of the mother. Part 2 examines alternative methods used or proposed to address the problem of substance-abusing pregnant women. Part 3 presents the various views of the legal and medical communities on the effectiveness of involuntary commitment or incarceration during a pregnancy. Part 4 offers suggestions for a way of dealing with the problem. The U.S. Supreme Court has not recognized any constitutional protections for the unborn. Nevertheless, fetal rights have evolved in the common law. Probate law and tort law provide a right of action for a viable fetus who is later born alive. Criminal law has been slower to progress, but has adopted the idea that once the fetus is viable, any injury to the fetus by a third-party is an offense if the child is born alive, or if the accused is charged under a feticide statute. When a woman delivers an illicit substance to her child, this behavior does not become an offense under child welfare or criminal statutes until the child is physically separated from the mother. In recognition of this fact, some jurisdictions have held that an unborn fetus is a person or child protected by child welfare statutes, once fetus reaches the point of “quickening,” that is when the fetus can survive apart from its mother. State action committing pregnant women to drug treatment after the point of quickening would not violate a woman’s constitutional right to terminate her pregnancy. The U.S. Supreme Court has not yet addressed the issue of involuntary commitment of pregnant, substance-abusing women. Nonetheless, the Court has found that involuntary civil commitment does not offend the substantive due process rights of a child molester, even when treatment is an overriding concern, if the commitment proceedings follow appropriate procedures. By comparison, the involuntary commitment of a pregnant, substance-abusing woman who poses a threat to her unborn child after quickening should not violate her due process rights. The author then examines various court decisions and the medical community views on dealing with substance-abusing pregnant women. The medical community, for example, has rejected incarceration for substance abuse as unworkable and self-defeating. The author concludes by offering the following model to address the problem of pregnant, substance-abusing women: 1) mandatory reporting and referral of substance-abusing pregnant women by health care providers and other who are mandated to report under child welfare statutes; 2) alternative methods for the pregnant, substance-abusing woman to voluntarily enter treatment; 3) juvenile court involvement in a monitoring capacity and as an incentive for the pregnant substance-abusing woman to complete substance abuse treatment; 4) an in-patient facility similar to domestic violence shelters; 5) facilities on-site to house any other children of the pregnant, substance-abusing woman; and 6) case managers to follow the pregnant, substance-abusing woman’s progress after release from the program.