Substance Use Treament in Pregnancy

Experiences of Perinatal Substance Use Treatment in WNC

Rates of opioid use disorder (OUD) in pregnancy have increased significantly over the past 20 years presenting serious health risks for both mothers and infants. The American College of Obstetrics and Gynecology recommends perinatal care that includes medication-assisted treatment (MAT) for pregnant women with OUD to mitigate these risks and support the healthiest possible pregnancy and birth outcome.

Women in rural southern Appalachia have the highest rates of OUD and the least access to perinatal substance use treatment and MAT in part due to fewer prescribers, less Medicaid coverage, greater barriers to accessing healthcare, and greater stigma.

In 2017, UNC Health Sciences at MAHEC researchers interviewed patients and providers from a comprehensive perinatal substance use treatment program that serves women from across Western North Carolina. This program is located within a large ob/gyn practice that provides high-risk and safety net care as well as MAT and integrated behavioral health services.

In response to preliminary findings, providers in the program adjusted messaging about MAT to better address patient concerns, worked with nurse educators at the hospital where participants delivered to improve the labor and delivery experience, and are revising the process for offering wraparound services to reduce the potential for overwhelm.

Additional recommendations include identifying and sharing local and regional transportation resources with patients, providing enhanced support for postpartum transition to community-based care, and conducting future research to better understand how stigma and public policies regarding substance use and treatment affect patients’ treatment choices.

Research from this project has been accepted for publication in the Journal of Addiction Medicine. The published research may be viewed here.

Principal investigators: Bayla Ostrach, PhD, Department of Research, Catherine Leiner, BS, Davidson Impact Fellow, UNC Health Sciences at MAHEC.