Purpose: To inform obstetricians
of potential barriers to engagement in perinatal substance use treatment, as
reported by patients in a comprehensive program.
Background: Opioid
use disorder in pregnancy diagnoses have rapidly increased, 127% from 1998 to
2011. Comprehensive perinatal substance use treatment including
medication-assisted treatment (MAT) is recommended to reduce risks for the
mother-baby dyad: however, access to this treatment remains limited. While OUD
is a pervasive perinatal health issue, Ob/Gyns may lack awareness of their
patients’ needs and concerns related to it.
Methods: This
qualitative study combined semi-structured interviews and
participant-observation with patients in a comprehensive perinatal substance
use treatment program, in a largely rural Appalachian region. Sampling was
opportunistic and purposive; all data were analyzed using modified Grounded
Theory.
Results: Twenty-seven
MAT patients participated in prenatal and/or postpartum interviews, and were
observed (along with a larger cohort in care during the four-month study
period) in the clinical setting. Participants described the importance of
receiving supportive care in a non-judgmental clinical setting, in contrast
with past experiences of stigmatizing treatment. Many participants reported
concerns about social services involvement with the current pregnancy or
existing children, as a factor influencing their comfort seeking substance use
treatment during pregnancy.
Discussions: Concerns about the
external consequences of substance use treatment shape women’s experience
seeking clinical care. Clinicians addressing patient concerns about social
services involvement and a non-judgmental approach overall facilitate
engagement with care. With the increase of OUD in pregnancy, obstetric faculty
benefit from understanding patient perspectives on barriers to care.
Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Patient Care, Medical Knowledge, Interpersonal & Communication Skills, GME, CME, Public Health, Advocacy, General Ob-Gyn,
Nathan Mullins,
MD, UNC
Health Sciences at MAHEC; Mountain Area Health Education Center; Melinda Ramage,
MSN, FNP-BC; Bayla Ostrach, PhD; Catherine
Leiner, BS
