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Addressing Patient Fears in Perinatal Substance Use Treatment

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,

General Information

Patient Care,Medical Knowledge,Interpersonal & Communication Skills,
Public Health,Advocacy,
Clinical Focus
General Ob-Gyn,

Author Information

Nathan Mullins, MD, UNC Health Sciences at MAHEC; Mountain Area Health Education Center; Melinda Ramage, MSN, FNP-BC; Bayla Ostrach, PhD; Catherine Leiner, BS

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