Provider Characteristics Associated with Trust When Caring for Women Experiencing Substance Use Disorders in the Perinatal Period

Abstract

Introduction Women experiencing substance use disorders (SUD) have often reported challenges in their relationships with health care providers during the perinatal period that served as a barrier to care. Establishing trust is an important aspect in forming positive relationships. The purpose of this study was to identify provider characteristics associated with the development of trust when caring for women experiencing SUD during the perinatal period. Methods A systematic search was conducted using the databases of CINAHL, APA PsychINFO, and PubMed along with a manual search of Google Scholar between the years of 2000‐2021. Studies were included if they were (1) original qualitative research; (2) published in English; (3) peer reviewed; (4) from the perspective of women experiencing SUD; (5) included descriptions of positive health care interactions between women experiencing SUD in the perinatal period and their health care providers; and (6) conducted in the United States or Canada. The studies were assessed for quality and validity using 10 criteria from the Joanne Briggs Institute critical appraisal checklist for qualitative research. Results Findings from 21 qualitative studies were synthesized using a thematic synthesis approach and revealed 3 overarching themes that included 7 descriptive subthemes which identified provider characteristics associated with trust. The 7 descriptive subthemes included: developing rapport with women, demonstrating caring behaviors, including women in care, understanding women's SUD treatment efforts, reassuring women, delivering competent care, and educating women. Discussion Participants’ accounts of trusting interactions with health care providers occurred when providers viewed women approvingly, affirmed their treatment efforts and maternal abilities, and delivered competent care that was knowledgeable of issues associated with SUD. The findings suggest the importance of confronting implicit biases, integrated care, and fostering a stigma‐free and trauma‐informed working environment.

Demographics, Birth Parameters, and Social Determinants of Health Among Opioid-Exposed Mother-Infant Dyads Affected by Neonatal Abstinence Syndrome in Pennsylvania, 2018–2019

“…Prior research suggests that barriers to entry into prenatal care among women using substances may include lack of transportation, mistrust of the medical system, and fear of stigma or legal implications (Frazer et al, 2019 ). These barriers highlight the importance of trauma-informed, supportive care from unbiased providers throughout the perinatal period (Renbarger et al, 2022 ). Strategies that promote comprehensive prenatal care, address barriers and concerns, and allow for honest communication about substance use with a trusted provider should be prioritized.…”

Advanced Practice Provider–Led Medication for Opioid Use Disorder Programs for Pregnant and Parenting Women

“…24 APPs are well suited to treat patients with OUD given nursing and midwifery philosophies based on whole-person care that perfectly align with this work. Renbarger et al 25 determined, through systematic review, that pregnant patients with substance use disorders valued health care providers who demonstrated caring behaviors, included women in planning care, demonstrated competence specific to substance use treatment, and provided patient education, characteristics central to nursing and midwifery care.…”

A Longitudinal Qualitative Study of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy

“…11,13,20 Additionally, there is inconsistency in professional practice to support breastfeeding in women on OMT. 14,16,21 Current understanding of the barriers to breastfeeding among women on OMT does not fully explain the gap between intention to breastfeed and actual practice. Yonke et al reported low breastfeeding incidence among women on OMT at hospital discharge and at 2-month follow-up, even though 92% of the cohort stated their intention to breastfeed prenatally while in treatment, receiving prenatal care, and delivering in a hospital that actively supported breastfeeding.…”

“…Clinicians and scholars recognize that women on OMT may experience barriers to breastfeeding beyond those of the general population 11-13. Several studies have found factors that prevent successful breastfeeding in women on OMT, including inaccurate information, misconceptions, and lack of support from providers and nurses 14-16. Other studies describe social factors that impact a woman’s self-confidence in breastfeeding, such as stigma against addiction and breastfeeding, fears and anxieties about the newborn’s health, and a lack of support from family and friends 11,17.…”

“…Social stigma, self-efficacy/perceived behavioral control, and receipt of conflicting information make breastfeeding decisions more complex for women with OUD 11,13,20. Additionally, there is inconsistency in professional practice to support breastfeeding in women on OMT 14,16,21. Current understanding of the barriers to breastfeeding among women on OMT does not fully explain the gap between intention to breastfeed and actual practice.…”