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

Morton, Jamie; Vignato, Julie; Anbari, Allison B.

doi:10.1177/01939459231182495

Cited by 6 publications

(3 citation statements)

References 40 publications

(309 reference statements)

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“…We therefore measured intimate partner or family violence (IPFV) during or 12 months before pregnancy by one’s husband, current or ex-partner, or another family member. Prior studies have shown that some physical and mental health conditions (eg, excess body weight and behavioral health disorders) carry stigmas that negatively shape health care professionals’ care and attitudes towards patients . We measured obesity (body mass index ≥30 [calculated as weight in kilograms divided by height in meters squared]) prior to pregnancy and self-reported diagnosis of the following conditions before or during pregnancy: chronic medical conditions (asthma, diabetes, or hypertension), substance use disorder (SUD) or addiction (excluding smoking or tobacco use), and mood disorders (depression, anxiety, or another mood disorder).…”

Section: Methodsmentioning

confidence: 99%

Disparities in Mistreatment During Childbirth

Liu,

Underhill,

Aubey

et al. 2024

JAMA Netw Open

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ImportanceLack of respectful maternity care may be a key factor associated with disparities in maternal health. However, mistreatment during childbirth has not been widely documented in the US.ObjectivesTo estimate the prevalence of mistreatment by health care professionals during childbirth among a representative multistate sample and to identify patient characteristics associated with mistreatment experiences.Design, Setting, and ParticipantsThis cross-sectional study used representative survey data collected from respondents to the 2020 Pregnancy Risk and Monitoring System in 6 states and New York City who had a live birth in 2020 and participated in the Postpartum Assessment of Health Survey at 12 to 14 months’ post partum. Data were collected from January 1, 2021, to March 31, 2022.ExposuresDemographic, social, clinical, and birth characteristics that have been associated with patients’ health care experiences.Main Outcomes and MeasuresAny mistreatment during childbirth, as measured by the Mistreatment by Care Providers in Childbirth scale, a validated measure of self-reported experiences of 8 types of mistreatment. Survey-weighted rates of any mistreatment and each mistreatment indicator were estimated, and survey-weighted logistic regression models estimated odds ratios (ORs) and 95% CIs.ResultsThe sample included 4458 postpartum individuals representative of 552 045 people who had live births in 2020 in 7 jurisdictions. The mean (SD) age was 29.9 (5.7) years, 2556 (54.4%) identified as White, and 2836 (58.8%) were commercially insured. More than 1 in 8 individuals (13.4% [95% CI, 11.8%-15.1%]) reported experiencing mistreatment during childbirth. The most common type of mistreatment was being “ignored, refused request for help, or failed to respond in a timely manner” (7.6%; 95% CI, 6.5%-8.9%). Factors associated with experiencing mistreatment included being lesbian, gay, bisexual, transgender, queer identifying (unadjusted OR [UOR], 2.3; 95% CI, 1.4-3.8), Medicaid insured (UOR, 1.4; 95% CI, 1.1-1.8), unmarried (UOR, 0.8; 95% CI, 0.6-1.0), or obese before pregnancy (UOR, 1.3; 95% CI, 1.0-1.7); having an unplanned cesarean birth (UOR, 1.6; 95% CI, 1.2-2.2), a history of substance use disorder (UOR, 2.6; 95% CI, 1.3-5.1), experienced intimate partner or family violence (UOR, 2.3; 95% CI, 1.3-4.2), mood disorder (UOR, 1.5; 95% CI, 1.1-2.2), or giving birth during the COVID-19 public health emergency (UOR, 1.5; 95% CI, 1.1-2.0). Associations of mistreatment with race and ethnicity, age, educational level, rural or urban geography, immigration status, and household income were ambiguous.Conclusions and RelevanceThis cross-sectional study of individuals who had a live birth in 2020 in 6 states and New York City found that mistreatment during childbirth was common. There is a need for patient-centered, multifaceted interventions to address structural health system factors associated with negative childbirth experiences.

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Section: Methodsmentioning

confidence: 99%

Disparities in Mistreatment During Childbirth

Liu,

Underhill,

Aubey

et al. 2024

JAMA Netw Open

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“…Pregnant women with OUDs often lack information or receive misinformation about OUD treatment and its impact on themselves and their babies [ 10 ]. A lack of adequate communication, breakdown in communication, or miscommunication experienced by pregnant women with opioid use disorders worsens perceptions of stigma from clinicians [ 11 ]. Therefore, the intentional education of patients about treatment options may reduce misinformation and stigma and may facilitate shared decision making.…”

Section: Introductionmentioning

confidence: 99%

Development of an Educational Brochure about Treatment Options for Pregnant Women with Opioid Use Disorders

Jeminiwa,

Park,

Popielaski

et al. 2024

Pharmacy

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The goal of this study was to describe the development of an educational brochure for pregnant women with opioid use disorders (OUDs) about treatment options. Based on findings from a preliminary review of the literature, we drafted a brochure that addressed the following questions: (1) What are your options (Medication-Assisted Treatment (MAT) versus no treatment)? (2) What are the benefits of MAT? (3) What are the risks of MAT? (4) Can I take buprenorphine or methadone while breastfeeding? (5) Which medication should I choose? Clinicians and doulas (n = 19) who provide care to pregnant women with OUDs were recruited. Semi-structured interviews elicited participants’ feedback on brochure content and their perceptions about brochure use for patient education. Thematic data analyses were performed. Three emergent themes were identified (suggested uses and settings of use, content revisions, and perceptions about the brochure) and used to refine the final brochure. This study provides valuable insights into the desired content of an educational brochure describing treatment options for pregnant women with OUDs from the provider’s standpoint. Research is needed to assess the use of the brochure in shared decision-making conversations with providers about treatment.

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“…Unfortunately, breastfeeding rates in this vulnerable group are lower than the general population, even though they intend to establish and continue breastfeeding beyond the first few weeks 2,10. 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.…”

mentioning

confidence: 99%

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

Doerzbacher,

Sperlich,

Hequembourg

et al. 2024

Journal of Perinatal &Amp; Neonatal Nursing

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Purpose: To understand how barriers and facilitators interact over time to support or disrupt breastfeeding among women on opioid maintenance therapy for opioid use disorder. Background: Breastfeeding has additional benefits for newborns with prenatal opioid exposure. Up to 80% of women on opioid maintenance therapy plan to breastfeed, but many do not beyond the first 7 to 10 days. Methods: A qualitative, longitudinal design was used. Semi-structured interviews occurred during the third trimester of pregnancy and again between 1 and 6 weeks postpartum. Thematic analysis was conducted using the Breastfeeding in a Life Course Context model as a framework. The design and methods were informed by a post-positivist, critical realist perspective. Results: Thirteen participants were enrolled, and 19 interviews were completed. Five themes were identified. It Will Work Out was the primary theme that describes participants’ sense of self-efficacy, stemming from their experiences of managing addiction recovery. Women considered breastfeeding to support their own health and that of their newborn while in recovery, summarized by Being Healthy. Making the choice to breastfeed, represented by Weighing the Options, was influenced by their perinatal health care providers. During the Sensitive Period, challenges could overwhelm their self-efficacy. Of 9 women, 4 were still breastfeeding when interviewed postpartum, exemplified by Moving On. Conclusions and Implications for Practice: Participants’ self-efficacy and motivation to be healthy played a significant role in managing breastfeeding challenges over time. Nursing interventions must empower women’s self-efficacy to help them achieve their breastfeeding goals.

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

Cited by 6 publications

References 40 publications

Disparities in Mistreatment During Childbirth

Disparities in Mistreatment During Childbirth

Development of an Educational Brochure about Treatment Options for Pregnant Women with Opioid Use Disorders

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

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