More data are needed regarding the screening policies of perinatal units for illicit drugs, especially in states where positive drug test results are linked with child neglect. The process by which pregnant women and infants are selected for illicit drug testing has caused concern because it may lead to bias and overrepresentation of certain populations in the drug-using groups. To examine hospital policies for screening women and newborn infants in prenatal, labor, and newborn hospital units, we conducted a telephone and follow-up mail survey of 49 Chicago-area hospitals. Nurse administrators or clinical specialists were questioned about the criteria used to select mothers and infants for testing, the extent to which written informed or oral consent was obtained for drug tests, and the actions taken by hospitals in response to positive drug test results in infants. Variations in policy among hospitals and hospital units were evident. The most frequently cited criteria for testing mothers and infants for drug use were verbal admission of drug use, the health provider's suspicion of drug use, a positive diagnosis of human immunodeficiency virus or a sexually transmitted disease in the mother, or a combination of these criteria. Universal drug screening may be a viable option when sanctions are the consequence of perinatal drug testing. The removal of sanctions, however, and a return to disclosure within a supportive client-caregiver relationship are the preferred options.