Opioid use in pregnancy and the postpartum period increases the vulnerability of the newborn in many ways. No single system can appropriately meet all the needs of this population. Due to the variety of systems that are involved, there are multiple opportunities for gaps in care. Thus, the systems of care must collaborate, communicate, and share information in an effective manner in order to provide optimal care. This article uses the metaphor of driving on a long journey with many twists and turns to illustrate the various aspects of opioid use in pregnancy, the challenges to intervention, and how to effectively support children and families in recovery.