While many women with substance use disorders can achieve abstinence during pregnancy, the postpartum period is a time of increased vulnerability to relapse. The first year postpartum is a particularly vulnerable time for women with opioid use disorder (OUD). Relapse is common, and studies have noted increased rates of both fatal and non-fatal overdoses during the postpartum period. Given this significant vulnerability, it is essential that women with opioid use disorders continue in treatment throughout pregnancy and into the postpartum period.
Evidence-based OUD treatment for pregnant and postpartum women includes medication for OUD or MOUD (i.e., buprenorphine, methadone) and wrap-around services; this kind of comprehensive care decreases overdose risk and improves pregnancy outcomes. In addition, the initiation of MOUD during pregnancy increases the likelihood of continuing OUD treatment during the first year postpartum.
A recent study from Martin and colleagues at Virginia Commonwealth University takes a look at factors related to the postpartum transition which impact recovery in postpartum women receiving MOUD. In this qualitative study, semi-structured interviews were conducted with 12 postpartum women in OUD treatment and 9 providers at a multidisciplinary outpatient addictions clinic. Interviews were transcribed and analyzed using an “editing style approach” to uncover common themes and identify quotes related to women’s and providers’ experiences with OUD treatment during the postpartum period.
Based on their interviews of patients, the researchers identified several different factors which promoted recovery (Figure 1): maternal bonding with the infant, parenting support, engagement with a OUD treatment program, and having a strong recovery-based support network. The providers also identified factors promoting recovery: parenting support, engagement with an OUD treatment program, patient-centered compassionate care, and a strong peer support recovery network.
But there were also, not so surprisingly, factors which presented barriers to recovery. Patients reported guilt related to having a child with neonatal opioid withdrawal syndrome (NOWS) as a result of medications used for OUD, mental health (depression and/or anxiety), pain associated with labor and delivery, parenting stress, and stigma. Providers noted factors a similar set of factors challenging OUD treatment: lack of information about NOWS including its assessments and provider roles, mental health, misinformation regarding postpartum pain management, mistrust of healthcare providers, parenting stress (especially related to NOWS), and stigma.
The state of Virginia has a mandatory reporting policy. While most patients reported that involvement of child protective services was a barrier to their recovery, some viewed the involvement of child protective services as promoting recovery. Providers noted that many women in OUD treatment have strong negative perceptions about child protective services; however, educating patients about the utility of child protective services appeared to facilitate recovery.
This is a small qualitative study including a small subset of postpartum women in MOUD treatment. However, the findings are consistent with larger studies in perinatal women and this study yields important information on how to improve the quality efficacy of recovery-oriented care for perinatal women in treatment for OUD. The authors emphasize the importance of guiding health systems in the provision of evidence-based, “person-centered, trauma-informed, compassionate care tailored to the unique needs of the mother-infant dyad affected by OUD”.
Ruta Nonacs, MD PhD
Martin CE, Almeida T, Thakkar B, Kimbrough T. Postpartum and addiction recovery of women in opioid use disorder treatment: A qualitative study. Subst Abus. 2021 Jul 2:1-8.