A Qualitative Study of Pregnancy and Birth Experience for Women with Opioid Use Disorder and a History of Sexual Trauma [22B

Abstract

INTRODUCTION: Opioid use in pregnancy has increased dramatically, paralleling the epidemic observed in the general population. Many of these women have a history of sexual trauma. Our objective was to identify factors that adversely affect the labor and delivery experience for women with opioid use disorder and concomitant sexual trauma history. METHODS: This is a subgroup analysis of 13 women with a history of sexual trauma who participated in an opioid replacement therapy program during pregnancy. Participants underwent semi-structured qualitative interviews for a study about women with a history of sexual trauma. Interviews focused on the antenatal, intrapartum, and immediate post-partum experiences. RESULTS: Participants felt stigmatized by unfamiliar providers for their opioid use disorder and voiced desire for a childbirth experience unaffected by addiction, except when medically necessary. Most participants were concerned their opioid tolerance would lead to inadequate intrapartum pain management. Many felt they received less breastfeeding encouragement than women without opioid use disorder. Separation from infants for routine care or management of neonatal abstinence syndrome without adequate explanation concerned participants. In this situation, many feared they had lost custody, felt there was little institutional concern for maternal-infant bonding and reported guilt about the impact of addiction on the infant. CONCLUSION: Women with opioid use disorder and concomitant sexual trauma history report distrust of the medical system. Emphasizing established therapeutic relationships, ensuring clear communication regarding intrapartum pain control, promoting infant care in the post-partum room, and reinforcing legal determination of custody may improve labor and delivery experiences for this group of women.