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Doerzbacher M, Sperlich M, Hequembourg A, Chang YP. A Longitudinal Qualitative Study of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy. J Perinat Neonatal Nurs 2024; 38:306-314. [PMID: 39074327 DOI: 10.1097/jpn.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
PURPOSE To understand how barriers and facilitators interact over time to support or disrupt breastfeeding among women on opioid maintenance therapy for opioid use disorder. BACKGROUND Breastfeeding has additional benefits for newborns with prenatal opioid exposure. Up to 80% of women on opioid maintenance therapy plan to breastfeed, but many do not beyond the first 7 to 10 days. METHODS A qualitative, longitudinal design was used. Semi-structured interviews occurred during the third trimester of pregnancy and again between 1 and 6 weeks postpartum. Thematic analysis was conducted using the Breastfeeding in a Life Course Context model as a framework. The design and methods were informed by a post-positivist, critical realist perspective. RESULTS Thirteen participants were enrolled, and 19 interviews were completed. Five themes were identified. It Will Work Out was the primary theme that describes participants' sense of self-efficacy, stemming from their experiences of managing addiction recovery. Women considered breastfeeding to support their own health and that of their newborn while in recovery, summarized by Being Healthy. Making the choice to breastfeed, represented by Weighing the Options, was influenced by their perinatal health care providers. During the Sensitive Period, challenges could overwhelm their self-efficacy. Of 9 women, 4 were still breastfeeding when interviewed postpartum, exemplified by Moving On. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Participants' self-efficacy and motivation to be healthy played a significant role in managing breastfeeding challenges over time. Nursing interventions must empower women's self-efficacy to help them achieve their breastfeeding goals.
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Affiliation(s)
- Margaret Doerzbacher
- University at Buffalo School of Nursing, Buffalo, New York (Drs Doerzbacher, Hequembourg, and Chang); and University at Buffalo School of Social Work, Buffalo, New York (Dr Sperlich)
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Harris M, Schiff DM, Saia K, Muftu S, Standish KR, Wachman EM. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeed Med 2023; 18:715-733. [PMID: 37856658 PMCID: PMC10775244 DOI: 10.1089/bfm.2023.29256.abm] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.
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Affiliation(s)
- Miriam Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Davida M. Schiff
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Kelley Saia
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Serra Muftu
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Katherine R. Standish
- Department of Family Medicine, and Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Elisha M. Wachman
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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Standish KR, Morrison TM, Wanar A, Crowell L, Safon CB, Colson E, Drainoni ML, Colvin BN, Friedman H, Schiff DM, Stulac S, Costello E, Parker M. Breastfeeding Decision-Making Among Mothers with Opioid Use Disorder: A Qualitative Study. Breastfeed Med 2023; 18:347-355. [PMID: 37115582 DOI: 10.1089/bfm.2022.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Background: Factors that contribute to low initiation and continuation of breastfeeding among mothers with opioid use disorder (OUD) are poorly understood. Objective: To understand barriers and facilitators to breastfeeding initiation and continuation beyond the birth hospitalization for mothers with OUD. Materials and Methods: We conducted 23 in-depth, semistructured interviews with mothers with OUD who cared for their infants at home 1-7 months after birth. Our interview guide was informed by the Theory of Planned Behavior (TPB) framework, which has been used to understand decision-making regarding breastfeeding. An iterative approach was used to develop codes and themes. Results: Among 23 participants, 16 initiated breastfeeding, 10 continued after hospital discharge, and 4 continued beyond 8 weeks. We identified factors influencing breastfeeding decisions in the four TPB domains. Regarding attitudes, feeding intentions were based on beliefs of the healthiness of breastfeeding particularly pertaining to infant withdrawal or exposure to mothers' medications. Regarding social norms, breastfeeding was widely recommended, but mothers had varying levels of trust in medical professional advice. Regarding perceived control, infant withdrawal and maternal pain caused breastfeeding to be difficult, with decisions to continue modulated by level of outside support. Regarding self-efficacy, mothers weighed their own recovery and well-being against the constant demands of breastfeeding, impacting decisions to continue. Conclusion: Mothers with OUD face unique barriers to breastfeeding related to their infants' withdrawal as well as their own health, recovery, and social context. Overcoming these barriers may serve as future intervention targets for breastfeeding promotion among this high-risk population.
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Affiliation(s)
- Katherine R Standish
- Department of Family Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Tierney M Morrison
- Department of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amita Wanar
- Department of Obstetrics and Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Lisa Crowell
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Cara B Safon
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Eve Colson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Bryanne N Colvin
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Davida M Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Sara Stulac
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Eileen Costello
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Margaret Parker
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Doerzbacher M, Sperlich M, Hequembourg A, Chang YP. Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy. J Obstet Gynecol Neonatal Nurs 2021; 51:29-40. [PMID: 34655544 DOI: 10.1016/j.jogn.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes. DATA SOURCES We searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid. STUDY SELECTION We included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review. DATA EXTRACTION We extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT. DATA SYNTHESIS We identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors. CONCLUSION The results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.
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McQuade M, Reddy N, Barbour K, Owens L. Integrating reproductive health care into substance use disorder services. Int Rev Psychiatry 2021; 33:572-578. [PMID: 33974476 DOI: 10.1080/09540261.2021.1904845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People who use drugs face layered stigma and barriers to accessing reproductive health care services. At the same time, they have unique needs for compassionate, trauma-informed, low-barrier reproductive health care. We review the literature on collocated reproductive health care and substance use treatment services in this population and advocate for expansion of reproductive health care services at sites providing care for substance use disorder. Through this review article, we outline the evidence for and best practices in collocating reproductive health care within substance use disorder services.
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Affiliation(s)
- Miriam McQuade
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Neha Reddy
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kyle Barbour
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - Lauren Owens
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Cook KJ, Larson KL. Breastfeeding Decision-Making in an Addiction Trajectory: An Exploratory Grounded Theory Study. Res Theory Nurs Pract 2020; 34:371-388. [PMID: 33199409 DOI: 10.1891/rtnp-d-20-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Globally, five million women are affected by opioid use disorder (OUD). Women with OUD are less likely to breastfeed than the general population, increasing risk of neonatal withdrawal. Theoretical frameworks related to breastfeeding did not address women with OUD. The purpose of this study was to develop a conceptual model to better understand breastfeeding disparities among this vulnerable population. METHODS A grounded theory study was conducted from August 2018 to March 2019 to investigate concepts likely to influence breastfeeding decisions in women with OUD. In-depth interviews were conducted in North Carolina with 10 women in recovery who breastfed, and their six identified support persons. Data were analyzed through iterative coding. This article focuses on maternal perspectives of breastfeeding informed by support persons. RESULTS The overarching theme was breastfeeding decision-making in an addiction trajectory. Two antecedent pathways led to the recovery-relapse cycle. This cycle involved seeking, initiating, and maintaining recovery with episodic relapse. Perceived stigma linked the recovery-relapse cycle with breastworks. Breastworks, an emergent concept, was characterized by learning and knowing, good intentions, and health-care provider sensitivity. IMPLICATIONS FOR PRACTICE This grounded theory model may inform clinicians in caring for women with OUD and support breastfeeding and newborn well-being. Strategies to address research and practice may include the development of a mobile application, having women in recovery on the health-care team, and incorporation of breastfeeding guidelines.
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Affiliation(s)
- Kristy J Cook
- East Carolina University College of Nursing, Greenville, NC
| | - Kim L Larson
- East Carolina University College of Nursing, Greenville, NC
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