INTRODUCTION: High incidences of opioid use disorder (OUD) during pregnancy and neonatal abstinence syndrome (NAS) are manifestations of the U.S. opioid epidemic. Buprenorphine is an effective treatment for OUD, but with restricted access due to prescribing barriers. Neonates with in-utero buprenorphine exposure have milder NAS symptoms and shorter hospital stays. We sought to describe the geographic distribution of buprenorphine-approved obstetrician-gynecologists (ob-gyns). METHODS: To identify buprenorphine-waiver status and geographic location, we linked the Drug Addiction Treatment Act buprenorphine-waived provider list to the Centers for Medicare & Medicaid Services Physician Compare dataset, and extracted all physicians of the specialty “obstetrics and gynecology.” We obtained state NAS data from state agencies' reports, and classified counties based on rural-urban continuum codes. RESULTS: Out of 31,211 obgyns who treat patients with Medicaid insurance, only 1.8% (560) can prescribe buprenorphine. Only 292 out of 3220 counties have at least 1 buprenorphine-approved ob-gyn. Among the 292, 76.4% (223) are metropolitan, 23.6% (69) are non-metropolitan. All 10 states with the highest opioid overdose deaths rates have at least 1 buprenorphine-approved ob-gyn (2 to 48). West-Virginia and Maine, however, have the highest NAS rates (50.6 and 80 per 1000 births respectively, compared to 8 nationally), but each have only 4 buprenorphine-approved ob-gyns. CONCLUSION: Buprenorphine is a mainstay and guideline-recommended treatment for OUD in pregnancy. The geographic distribution of buprenorphine-approved ob-gyns in the US is variable and does not reflect the incidence of NAS. Policy and educational interventions could improve buprenorphine access during pregnancy to limit the opioid epidemic's impact on maternal-fetal outcomes.