Identified Gaps and Opportunities in Perinatal Healthcare Delivery for Women in Treatment for Opioid use Disorder

Abstract

Background Pregnancy and the delivery of an infant mark a unique time of engagement in healthcare for women in treatment for opioid use disorder (OUD). The American College of Obstetrics and Gynecology calls for a comprehensive approach to perinatal healthcare delivery for pregnant women with OUD in order to facilitate improved health outcomes and increase patient-provider collaboration. Yet, there is little knowledge regarding the perceptions of women with OUD regarding the current delivery of healthcare which could inform a personalized, tailored approach to perinatal healthcare delivery. Methods Four focus groups consisting of 22 women with OUD were conducted, transcribed, and analysed using qualitative thematic analysis methodology. Results Women reported an overall lack of preparation for the birth and neonatal healthcare experiences and identified opportunities for greater support by the healthcare team. Women emphasized the desire for evidence-based preparation from trusted sources about delivery, neonatal abstinence syndrome, breastfeeding, and how their medications affect their pregnancy and baby. Women reported receiving a varied amount of support from healthcare providers in their transition to motherhood, but women predominantly reported receiving emotional and informational support from their mothers and partners. Conclusions The knowledge obtained in this study points to gaps in perinatal healthcare delivery for women with OUD. Improving the delivery of perinatal healthcare may contribute to increased engagement by women with OUD, and ultimately improve outcomes for a vulnerable population.

Stigma Experienced by Perinatal Women with Opioid Dependency in the United States: A Qualitative Meta-Synthesis

“…After application of inclusion and exclusion criteria to these articles' abstracts, this total was reduced to 26 articles. After a full-text assessment for eligibility was completed, 18 articles [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] were included (See Figure 1 for PRISMA diagram 20 ).…”

“…All studies explored the experiences of women with perinatal OUD during various points in the perinatal period (i.e., the prenatal, labor and delivery, and postpartum periods). [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Four studies explored infant care-related experiences in the postpartum period. 25,32,37,39…”

“…Nurses and healthcare providers, considered by women to include physicians, therapists, nurse assistants, and other allied health professions that work in conjunction with nurses, were perceived as denying access to these pivot points associated with patient-and family-centered care. 24,25,[32][33][34][35]36,39,40 This denial of access facilitated the stigma experience for women. However, if the nurses/healthcare providers deterred stigma in the care of perinatal women with OUD, women perceived that the nurses/healthcare providers were granting access to patient-and family-centered care.…”

Evaluating the Association between Prenatal Care Visits and Adverse Perinatal Outcome in Pregnancies Complicated by Opioid Use Disorder

“…20 Qualitative research has highlighted opportunities for improving prenatal care efficacy, specifically in preparing the mother physically and emotionally for delivery. 21 Furthermore, major identified barriers to prenatal care include addiction, transportation, childcare costs, provider shortages, and negative experiences with the health care system. 22 Importantly, research is still needed to identify the appropriate interventions to improve obstetrical and newborn outcomes in pregnancies affected by OUD.…”

What Obstetrician–Gynecologists Should Know About Substance Use Disorders in the Perinatal Period

“…243 For people with untreated addiction, the birthing hospitalization is an important opportunity to connect to continuing care, and everyone with SUD, not only those with OUD, should receive naloxone and training in its use before discharge. 72 Peer recovery support 193,244,245 and trauma-informed doula 246 care should also be considered as an effective method of providing compassionate care for this population.…”