Addressing Patient Fears in Perinatal Substance Use Treatment

Abstract

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. DISCUSSION: 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.