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Renbarger KM, Slater G, Phelps B, Brewer L. Perceptions of Supportive Factors for Reducing Risk of Maternal Mortality Among Women With Substance Use Disorders in a Rural Setting. Nurs Womens Health 2024; 28:356-365. [PMID: 39134092 DOI: 10.1016/j.nwh.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/22/2024] [Accepted: 07/01/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE To describe perceptions of supportive factors for reducing the risk of maternal mortality among women with substance use disorders (SUDs) in a rural setting. DESIGN Qualitative descriptive design. SETTING/LOCAL PROBLEM Participants were recruited from a rural setting in a U.S. Midwest state where rates of maternal substance use and maternal mortality are high. PARTICIPANTS Sixteen participants were recruited from a maternal residential substance use treatment center. INTERVENTION/MEASUREMENTS Semistructured interviews were used during which participants described their perceptions of maternal mortality and their related experiences. We analyzed the transcribed interviews using a basic inductive content analysis to yield themes and subthemes. RESULTS We identified three main themes: Social Networks, Respectful Perinatal Care, and Residential Substance Use Treatment. CONCLUSION Our findings suggest that nurses and other health care providers should be knowledgeable of resources to increase the social networks of women with SUD, recognize and manage the biases and judgments they may hold against women with SUD, and advocate for and refer women with SUD to residential substance use treatment.
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Renbarger KM, Anyango J, Pannell A. Nursing Students' Attitudes Toward Women With Maternal Substance Use Disorders. J Nurs Educ 2024; 63:659-664. [PMID: 39388465 DOI: 10.3928/01484834-20240530-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
BACKGROUND Maternal substance use disorders (SUD) have challenged relationships between women with SUD and their nurses. Nurses have reported biased attitudes toward women with SUD, which can interfere with their care. However, it is not well known how nursing students perceive women with SUD and their infants. This article describes nursing students' attitudes toward women with SUD, which can be used to inform educational strategies. METHOD An inductive content analysis was used to analyze 76 reflection papers written by nursing students at a midwestern university. RESULTS Three main themes were identified: (1) stigma toward women with SUD; (2) concerns for infants with neonatal abstinence syndrome; and (3) influence of clinical experiences on attitudes toward women with SUD. CONCLUSION Nursing students need more evidence-based guidance on managing their biases as well as the biases of nurses who work in maternity settings. [J Nurs Educ. 2024;63(10):659-664.].
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Martinez NG, Seidman DL, Briscoe H, Hayes CM, Ojukwu EI, Paltin D, Roberts SCM. Patients, colleagues, systems, and self: Exploring layers of physician emotions in caring for pregnant people who use substances and their newborns. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209432. [PMID: 38857826 DOI: 10.1016/j.josat.2024.209432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/24/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Pregnant people who use substances experience significant stigma, including in healthcare settings, where physicians make high-stakes decisions about treatment plans, resource allocation, and even a person's ability to parent. Previous psychology research has demonstrated the influence of emotions on decision-making, as well as on the development and expression of stigma. Yet the specific content of physician emotions, as well as approaches to processing these emotions, has been relatively under-examined. We sought to better understand the emotional experiences of physicians who practice in safety-net labor and delivery/inpatient settings to inform strategies to facilitate more humanizing, equitable care. METHODS From March 2021 to June 2022, the study team conducted semi-structured interviews with 24 San Francisco Bay Area-based physicians (obstetrics-gynecology, pediatrics, family medicine) caring for pregnant people who use substances and/or their newborns. We used deductive and inductive coding and identified themes regarding the nature, etiology, and processing of physician emotions. RESULTS Physicians described experiencing a range of emotions related to interpersonal (patients, colleagues), systems-level, and internal dynamics. Emotions such as anger, sadness, frustration, and helplessness resulted from their deep care and empathy for patients, witnessing stigmatizing colleague behaviors, disagreement with punitive systems, and recognition of their own limitations in effecting change. Few participants identified strategies for processing these emotions, and several described efforts to disengage from their emotional experience to preserve their sense of well-being and professionalism. CONCLUSIONS Physicians caring for pregnant people who use substances and their newborns experienced intense, multi-layered emotions. This study posits that additional efforts to support physician emotional processing and structural competency could improve healthcare experiences and outcomes for pregnant people who use substances.
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Affiliation(s)
- Noelle G Martinez
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, La Jolla, CA 92161, United States of America; Department of Family and Community Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America.
| | - Dominika L Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America
| | - Heather Briscoe
- Department of Pediatrics, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America
| | - Crystal M Hayes
- School of Social Work, Sacred Heart University, 5151 Park Avenue, Fairfield, CT 06825, United States of America
| | - Ekene I Ojukwu
- San Quentin Rehabilitation Center, 100 Main Street, San Quentin, CA 94964, United States of America
| | - Dafna Paltin
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 102/103, San Diego, CA 92120, United States of America
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Street, Suite 1100, Oakland, CA 94612, United States of America
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Renbarger KM. Factors Influencing Maternal Substance Use and Recovery in the Perinatal Period. West J Nurs Res 2024; 46:725-737. [PMID: 39058287 DOI: 10.1177/01939459241266736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Substance use disorders (SUD) in the perinatal period have risen dramatically over the past 2 decades. Substance use disorders can have deleterious effects on maternal-infant health. Recovery can improve quality of life but can be challenging for women with SUD in the perinatal period. It is important for health care providers to have an understanding of factors associated with maternal substance use and recovery. OBJECTIVE The purpose of this qualitative review was to identify factors influencing substance use and recovery in women with SUD in the perinatal period. METHODS A systematic search was conducted using the databases of CINAHL, PsycINFO, and PubMed along with a manual search of Google Scholar. The studies were assessed using criteria from the Joanna Briggs Institute's critical appraisal checklist for qualitative research. RESULTS Findings from 16 qualitative studies were synthesized. Six descriptive subthemes identifying factors influencing substance use and recovery were revealed: (1) Infant Care, (2) Stigma, (3) Social Settings Involving Substance Use, (4) Internalized Stigma and Mental Health Symptoms, (5) Addiction Concerns, and (6) Coping Abilities. CONCLUSIONS Participants described external and internal factors that influenced their substance use and recovery. The findings suggest health care providers refer women to residential addiction treatment, use destigmatizing language, promote access to peer services, and provide trauma-informed care.
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Bagwell GA, Kenner C. Changing the Lens on How We View Mothers of Neonates with Intrauterine Substance Exposure. J Perinat Neonatal Nurs 2024; 38:232-233. [PMID: 39074316 DOI: 10.1097/jpn.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
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Renbarger KM, Slater G, Phelps B. Knowledge of Maternal Mortality Risk Among Women with Substance Use Disorders during Pregnancy and Postpartum. MCN Am J Matern Child Nurs 2024; 49:38-43. [PMID: 38047602 DOI: 10.1097/nmc.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
PURPOSE The purpose of this study was to investigate knowledge of maternal mortality risk of women with substance use disorder in the perinatal period. STUDY DESIGN This study was conducted using a qualitative descriptive design. METHODS Participants were recruited from a residential substance use treatment center in a rural Midwestern city. We used semi-structured interviews during which participants described their understanding of maternal mortality risk and their related experiences. We analyzed the transcribed interviews using content analysis to yield themes and subthemes. RESULTS Sixteen women participated. Three main themes were identified: Women with substance use disorder lack understanding of maternal mortality; Women with substance use disorder experience barriers to perinatal care; and Women with substance use disorder have additional risk factors for maternal mortality. CLINICAL IMPLICATIONS Nurses can use validated screening tools, offer brief interventions, and refer women to appropriate substance use disorder treatment and mental health resources. Nurses must educate women with substance use disorder about their risk for maternal mortality as well as the signs and symptoms of perinatal mood and anxiety disorders. Nurses should provide education about the access and use of naloxone. A non-judgmental and trauma-informed approach should be used during interactions with this population.
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Martinez NG, Roberts SCM, Achu-Lopes RA, Samura TL, Seidman DL, Woodhams EJ. Reconsidering the use of urine drug testing in reproductive settings. Am J Obstet Gynecol MFM 2023; 5:101206. [PMID: 37871695 DOI: 10.1016/j.ajogmf.2023.101206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
The urine drug test is ubiquitous within reproductive healthcare settings. Although the test can have evidence-based use for a patient and clinician, in practice, it is often applied in ways that are driven by bias and stigma, do not correctly inform decisions about clinical aspects of patient care, and cause devastating ripple effects through social and legal systems. This paper proposes a framework of guiding questions to prompt reflection on (1) the question the clinical team is trying to answer, (2) whether a urine drug test answers the question at hand, (3) how testing benefits compare with the associated risks, (4) a more effective tool for clinical decision-making if the urine drug test does not meet the standards for use, and (5) individual and institutional biases affecting decision-making. We demonstrate the use of this framework using 3 common uses of the urine drug test within abortion care and labor and delivery settings.
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Affiliation(s)
- Noelle G Martinez
- Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Martinez).
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, CA (Dr Roberts)
| | - Rachel A Achu-Lopes
- Department of Anesthesia, Boston Medical Center, Boston University School of Medicine, Boston, MA (Dr Achu-Lopes)
| | - Tirah L Samura
- Los Angeles County Department of Health Services, Harbor-University of California Los Angeles Medical Center, Los Angeles, CA (Dr Samura); Los Angeles County Department of Health Services, Martin Luther King, Jr. Outpatient Center, Los Angeles, CA (Dr Samura)
| | - Dominika L Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Dr Seidman)
| | - Elisabeth J Woodhams
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston University School of Medicine, Boston, MA (Dr Woodhams)
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Renbarger KM, Phelps B, Broadstreet A, Abebe S. Factors Associated with Maternal Engagement in Infant Care When Mothers Use Substances. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:48-64. [PMID: 36874237 PMCID: PMC9983138 DOI: 10.1089/whr.2022.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 02/09/2023]
Abstract
Introduction Mothers who use substances can play a key role in the treatment and care of their infants. However, challenges exist to engaging these mothers in the care of their infant. The purpose of this study was to identify factors associated with maternal engagement in infant care when mothers are experiencing substance use disorders. Materials and Methods A systematic search was conducted using the databases of CINAHL, APA PsycINFO, and PubMed along with a manual search of Google Scholar between the years of 2012 and 2022. Studies were included if they were (1) original qualitative research; (2) published in English; (3) peer reviewed; (4) from the perspective of mothers who use substances or nurses; (5) included descriptions of interactions between mothers who use substances and their infants during postpartum care, and/or in the nursery or neonatal intensive care unit; and (6) conducted in the United States. The studies were assessed for quality and validity using 10 criteria from the Joanne Briggs Institute critical appraisal checklist for qualitative research. Results Findings from 22 qualitative studies were synthesized using a thematic synthesis approach and revealed 3 overarching themes that included 7 descriptive subthemes that identified factors to maternal engagement. The seven descriptive subthemes included: (1) Attitudes Toward Mothers Who Use Substances; (2) Knowledge on Addiction; (3) Complicated Backgrounds; (4) Emotional Experiences; (5) Managing Infant Symptoms; (6) Model of Postpartum Care; and (7) Hospital Routines. Discussion Participants described stigma from nurses, complex backgrounds of mothers who use substances, and postpartum models that influenced mothers' engagement in infants' care. The findings suggest several clinical implications for nurses. Nurses should manage their biases and approach mothers who use substances in a respectful manner, increase their knowledge of issues and care related to addiction in the perinatal period, and promote family-centered approaches to care. Conclusion The findings of 22 qualitative studies described factors associated with maternal engagement in mothers who use substances that were integrated using a thematic synthesis method. Mothers who use substances have complex backgrounds and experience stigma which can negatively impact their engagement with their infants.
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Affiliation(s)
| | - Barbara Phelps
- School of Nursing, Ball State University, Muncie, Indiana, USA
| | | | - Sheila Abebe
- School of Nursing, Ball State University, Muncie, Indiana, USA
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Stotts AL, Villarreal YR, Green C, Berens P, Blackwell S, Khan A, Suchting R, Velasquez M, Markham C, Klawans MR, Northrup TF. Facilitating treatment initiation and reproductive care postpartum to prevent substance-exposed pregnancies: A randomized bayesian pilot trial. Drug Alcohol Depend 2022; 239:109602. [PMID: 35987083 DOI: 10.1016/j.drugalcdep.2022.109602] [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] [Received: 05/13/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND For non-treatment-seeking women who use substances during pregnancy, immediately postpartum may be an optimum time for intervention. Our study tested a novel, brief, hospital-initiated, adaptive motivational interviewing plus acceptance and commitment therapy (MIACT) intervention to facilitate treatment initiation and reproductive planning postpartum among mothers who used substances during pregnancy. METHODS Mothers (N = 64) with an infant admitted to a neonatal intensive care unit were enrolled if they or their infant tested positive for an illicit substance at delivery or had a documented positive drug screen during pregnancy. A parallel group, randomized controlled design assigned participants to MIACT or conventional care (CC), with assessments at week 2 and 4 during treatment and follow-up at 2 and 6 months post treatment. Bayesian generalized linear modeling was used to evaluate outcomes as a function of treatment. RESULTS Results indicated that during treatment the MIACT group demonstrated an 84% probability of benefit relative to CC with regard to initiating treatment (RR=1.5), however the effect was not seen at follow-up. MIACT was also associated with an increased probability of attending a postpartum obstetrics visit (RR=1.4), and receiving contraception during treatment and at both follow-ups, with posterior probabilities of 96% or higher and relative risks ranging from 1.5 to 5.1 at varying timepoints. Substance use rates for the MIACT versus CC were higher at follow-up. CONCLUSIONS Brief, hospital-initiated interventions can assist postpartum mothers who use substances to enter treatment and obtain contraception in order to reduce future substance-exposed pregnancies.
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Affiliation(s)
- Angela L Stotts
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA.
| | | | - Charles Green
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
| | - Pamela Berens
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
| | - Sean Blackwell
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
| | - Amir Khan
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
| | - Robert Suchting
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
| | - Mary Velasquez
- The University of Texas at Austin, 1823 Red River St, Austin, TX 78712, USA
| | - Christine Markham
- UTHealth School of Public Health, 1200 Pressler, Houston, TX 77030, USA
| | | | - Thomas F Northrup
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
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Developments in Nursing Practice to Address Substance Use in the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2022; 51:361-376. [PMID: 35568096 DOI: 10.1016/j.jogn.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 12/30/2022] Open
Abstract
Since 1972, the year of the inaugural issue of Journal of Obstetric, Gynecologic, & Neonatal Nursing, substance use during pregnancy has remained a public health concern in the United States. This concern is currently exacerbated by factors such as the opioid and stimulant use crisis and widening health and social inequities for many women and families. The purposes of this historical commentary are to describe trends in the perception of women with substance use disorder and their infants and related sociolegal implications and to trace the evolution of related nursing practice and research during the past 50 years. We provide recommendations and priorities for practice and research, including further integration of support for the mother-infant dyad, cross-sectoral collaborations, and equity-oriented practices and policies.
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Anderson C, Braverman A, Maes P, Reising V. Lessons Learned From the Implementation of an Integrated Prenatal Opioid Use Disorder Program. Nurs Womens Health 2022; 26:215-225. [PMID: 35568062 DOI: 10.1016/j.nwh.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate key lessons learned from efforts at increasing engagement in integrated prenatal and opioid use disorder services. DESIGN An interdisciplinary team consisting of a board-certified obstetrician and registered nurse led the implementation of this multipronged approach driven by several plan-do-study-act cycles to develop an integrated prenatal and opioid use disorder program. SETTING/LOCAL PROBLEM An urban community health center in Chicago, Illinois, where mental health issues, including substance use, are the leading cause of death for pregnant people. PARTICIPANTS Connections were made with local harm reduction agencies, substance use treatment facilities, and community outreach programs to develop partnerships with organizations providing existing addiction and maternal-child services in the community. INTERVENTION/MEASURES Partnership building was achieved through organization needs assessments, dissemination of information about integrated services, and sustained communication. Referral workflow guides and patient education cards were created and distributed to community partners. Incoming referrals were tracked at the clinic site. Use of the referral materials was evaluated via online surveys distributed to community partners. RESULTS In the 18 weeks of enhanced integration, three patients engaged in services and were initiated on medication for opioid use disorder, two of whom had been referred from agencies targeted in the outreach efforts. Surveys showed that community partners believe the referral guides were easy to use and that the harm reduction information on the patient cards was useful. CONCLUSION An urban community health center was equipped to provide comprehensive, integrated services to pregnant people with opioid use disorder, but barriers such as community unawareness and stigma impeded engagement. Sustained collaboration with community partners serving pregnant people with opioid use disorder supports program development and linkage to care. Integrated prenatal and opioid use disorder care is feasible, us destigmatizing in nature, and can lead to improved maternal and fetal outcomes.
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Schiff DM, Work EC, Foley B, Applewhite R, Diop H, Goullaud L, Gupta M, Hoeppner BB, Peacock-Chambers E, Vilsaint CL, Bernstein JA, Bryant AS. Perinatal Opioid Use Disorder Research, Race, and Racism: A Scoping Review. Pediatrics 2022; 149:e2021052368. [PMID: 35156121 PMCID: PMC9044279 DOI: 10.1542/peds.2021-052368] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Racial/ethnic inequities are well documented in both maternal-infant health and substance use disorder treatment outcomes. OBJECTIVE To systematically review research on maternal-infant dyads affected by opioid use disorder (OUD) to evaluate for racial/ethnic disparities in health utilization or outcomes and critically assess the reporting and inclusion of race/ethnicity data. DATA SOURCES Peer-reviewed literature in MEDLINE, Embase, and Web of Science from 2000 to 2020. STUDY SELECTION Research reporting health utilization and outcomes data on dyads affected by OUD during pregnancy through the infant's first birthday. DATA EXTRACTION We extracted data on race/ethnicity, study exposures/outcomes, how race/ethnicity data were analyzed, how authors discussed findings associated with race/ethnicity, and whether racism was mentioned as an explanation for findings. RESULTS Of 2023 articles reviewed, 152 quantitative and 17 qualitative studies were included. Among quantitative studies, 66% examined infant outcomes (n = 101). Three articles explicitly focused on evaluating racial/ethnic differences among dyads. Among quantitative studies, 112 mentioned race/ethnicity, 63 performed analyses assessing for differences between exposure groups, 27 identified racial/ethnic differences, 22 adjusted outcomes for race/ethnicity in multivariable analyses, and 11 presented adjusted models stratified by race/ethnicity. None of the qualitative studies addressed the role that race, ethnicity, or racism may have had on the presented themes. CONCLUSIONS Few studies were designed to evaluate racial/ethnic inequities among maternal-infant dyads affected by OUD. Data on race/ethnicity have been poorly reported in this literature. To achieve health equity across perinatal OUD, researchers should prioritize the inclusion of marginalized groups to better address the role that structural racism plays.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Erin C. Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Bridget Foley
- Substance Use Disorder Initiative, Department of Psychiatry
| | | | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - Munish Gupta
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Judith A. Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, Boston Massachusetts
| | - Allison S. Bryant
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
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Welborn AC, Lewallen L, Nichols T. Exploration of the Care Giving Dynamic Between NICU Nurses and Mothers with a Substance-Exposed Pregnancy. Neonatal Netw 2022; 41:11-20. [PMID: 35105791 DOI: 10.1891/11-t-664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the caregiving dynamic between NICU nurses and mothers with a substance-exposed pregnancy (SEP) by examining how nurses view these mothers compared to mothers without an SEP. DESIGN A qualitative design using interviews with NICU nurses who care for infants and families with an SEP. SAMPLE The sample (n = 9) was all female, with an average of approximately 10 years of nursing experience in the NICU, with two-thirds having achieved a Bachelor of Science in Nursing (BSN) or higher. MAIN OUTCOME VARIABLE Perceptions of nurses working with families affected by an SEP. RESULTS Stigmatized views and trust issues shaped nurses' views of mothers with an SEP as different from other mothers. Empathy levels toward mothers differed related to nurses' views of substance use as either a moral decision or chronic disease. These viewpoints shaped the nurse's judgment of the mother's potential to provide a safe environment and independently care for the infant at home. Nurses described personal distress when caring for these families.
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Weber A, Miskle B, Lynch A, Arndt S, Acion L. Substance Use in Pregnancy: Identifying Stigma and Improving Care. Subst Abuse Rehabil 2021; 12:105-121. [PMID: 34849047 PMCID: PMC8627324 DOI: 10.2147/sar.s319180] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
This review examines the impact of stigma on pregnant people who use substances. Stigma towards people who use drugs is pervasive and negatively impacts the care of substance-using people by characterizing addiction as a weakness and fostering beliefs that undermine the personal resources needed to access treatment and recover from addiction, including self-efficacy, help seeking and belief that they deserve care. Stigma acts on multiple levels by blaming people for having a problem and then making it difficult for them to get help, but in spite of this, most pregnant people who use substances reduce or stop using when they learn they are pregnant. Language, beliefs about gender roles, and attitudes regarding fitness for parenting are social factors that can express and perpetuate stigma while facilitating punitive rather than therapeutic approaches. Because of stigmatizing attitudes that a person who uses substances is unfit to parent, pregnant people who use substances are at heightened risk of being screened for substance use, referred to child welfare services, and having their parental rights taken away; these outcomes are even more likely for people of color. Various treatment options can successfully support recovery in substance-using pregnant populations, but treatment is underutilized in all populations including pregnant people, and more knowledge is needed on how to sustain engagement in treatment and recovery activities. To combat stigma when working with substance-using pregnant people throughout the peripartum period, caregivers should utilize a trauma-informed approach that incorporates harm reduction and motivational interviewing with a focus on building trust, enhancing self-efficacy, and strengthening the personal skills and resources needed to optimize health of the parent-baby dyad.
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Affiliation(s)
- Andrea Weber
- Department of Psychiatry, University of Iowa Health Care, Iowa City, IA, USA
| | - Benjamin Miskle
- Department of Psychiatry, University of Iowa Health Care, Iowa City, IA, USA
| | - Alison Lynch
- Department of Psychiatry, University of Iowa Health Care, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Laura Acion
- Universidad de Buenos Aires - CONICET, Instituto de Cálculo, Ciudad Autónoma de Buenos Aires, Argentina
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Carpenter R, Smith MJ, Newhouse A. Mothering a child while participating in a substance use disorder program: A phenomenological study. Arch Psychiatr Nurs 2021; 35:577-582. [PMID: 34861948 DOI: 10.1016/j.apnu.2021.08.006] [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] [Received: 07/01/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to describe what it is like to live the everyday moments of mothering while actively participating in a substance use disorder (SUD) program from the mother's perspective. This study was guided by the research question: What is the structure of meaning of the lived experience of mothering a child while participating in a substance use disorder program? METHOD This qualitative study integrated phenomenology and story theory in the gathering and analysis of the stories. The study setting included two ambulatory clinics that are part of a larger biobehavioral health center of a large south-eastern academic medical center. Nine mothers confirmed voluntary participation, beginning in October 2020 through February 2021, yet only 4 could meet for face to face story gathering sessions. Van Manen's approach to data analysis was used to determine themes in the gathered stories. RESULTS The finding revealed six themes, along with specific descriptors in the words of the mothers. The themes were synthesized into a structure of meaning that includes: 1. Living the tensions of the everyday; 2. being pressured in mother/family/community relationships; and 3. reflecting on moving forward. These findings could be established in practice protocols for mothers in SUD recovery programs. CONCLUSION To support the mental health of mothers in SUD recovery programs, it is essential to understand their situation from their perspective. To get that perspective, the nurse needs to encourage the mother to share her experiences in SUD recovery programs.
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Affiliation(s)
- Roger Carpenter
- West Virginia University School of Nursing, Morgantown, WV 26506, United States of America.
| | - Mary Jane Smith
- West Virginia University School of Nursing, Morgantown, WV 26506, United States of America.
| | - Amanda Newhouse
- WVU Medicine, Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, Morgantown, WV 26508, United States of America.
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Edwards RC, Herriott AL, Finger B, Hans SL. Associations between parenting representations and behavior among young mothers and mothers with opioid use disorder. Infant Ment Health J 2021; 42:796-811. [PMID: 34647331 DOI: 10.1002/imhj.21948] [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] [Indexed: 11/08/2022]
Abstract
Mothers' representations reflect how they experience their child and their relationship, and can guide parenting behavior. While studies of representations typically focus on infancy, this study examines associations between mothers' representations and behavior with their preschoolers using two samples: young mothers (n = 201; 42% African American, 42% Latina, 8% European-American, 8% multi-ethnic; Mage = 32 months) and mothers in treatment for opioid use disorder (OUD; n = 150; 100% African American; Mage = 49 months). This study aims to identify the distribution of representations within these populations, differences in parenting between mothers classified with balanced and non-balanced representations, and distinct parenting behaviors associated with distorted and disengaged representations. The Working Model of the Child Interview was conducted to assess representations, and mother-child interactions were video-recorded. The distribution of balanced, distorted, and disengaged representations was 59%, 25%, and 15% among young mothers, and 21%, 39%, and 40% among mothers with OUD. Balanced representations (coherent, rich, engaged, respectful) were associated with positive parenting, including sensitivity, autonomy support, cognitive support and less negative regard among young mothers, and sensitivity and encouragement in the OUD sample. Mothers with disengaged representations (emotionally distant, lacking detail, indifferent) demonstrated less support for learning compared to mothers with distorted representations (involved but inconsistent, negative, or bizarre descriptions of child).
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Affiliation(s)
- Renee C Edwards
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois, USA
| | - Anna L Herriott
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois, USA
| | - Brent Finger
- Department of Psychology, Montana State University Billings, Montana, USA
| | - Sydney L Hans
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois, 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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Nurses' Descriptions of Interactions When Caring for Women With Perinatal Substance Use Disorders and Their Infants. Nurs Womens Health 2021; 25:366-376. [PMID: 34478736 DOI: 10.1016/j.nwh.2021.07.006] [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] [Received: 12/17/2020] [Revised: 04/02/2021] [Accepted: 07/22/2021] [Indexed: 01/15/2023]
Abstract
The purpose of this review is to describe health care interactions between nurses and women with perinatal substance use disorders, including interactions with their infants from the perspective of the nurses. Findings from 11 qualitative inclusion articles were synthesized using a metasummary approach. The majority of articles showed that nurses experience problematic interactions when providing care to women with perinatal substance use disorders and their infants, although some results indicated that some nurses engage in interactions that are assuring. Six types of conflictual interactions were identified: inadequate care, distressing, condemning, deficient knowledge, rejecting, and dissatisfying. Two types of therapeutic interactions were identified: compassionate and supportive. The findings underscore the importance of managing stigma, enhancing knowledge of the science of addiction processes, and promoting best practices when caring for this population.
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Cleveland LM, McGlothen‐Bell K, Scott LA, Recto P. A life-course theory exploration of opioid-related maternal mortality in the United States. Addiction 2020; 115:2079-2088. [PMID: 32279394 PMCID: PMC7587012 DOI: 10.1111/add.15054] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/22/2020] [Accepted: 03/17/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND AIMS Between 2007 and 2016, pregnancy-associated mortality resulting from overdose more than doubled in the United States. This study explored the circumstances surrounding maternal opioid-related morbidity and mortality, using the life-course theory as a sensitizing framework to examine how each participant's life-course contributed to her substance use, relapse, recovery or overdose. DESIGN A mixed-methods study using semi-structured, in-depth face-to-face interviews and focus groups were conducted. SETTING Texas, United States. PARTICIPANTS Women who had relapsed into opioid use or experienced a 'near-miss' overdose and family members of women who had died during the maternal period due to opioid overdose were interviewed (n = 99). MEASUREMENTS A socio-demographic questionnaire captured participants' ethnicity, age, marital status, medical and mental health history and employment status. The Stressful Life Events Screening Questionnaire-revised (SLESQ-R) assessed life-time exposure to trauma. FINDINGS Women reported histories of abuse and loss of a loved one through homicide or suicide. Participants indicated that limited social support, interpersonal conflict with their partner and unaddressed mental illness made recovery more challenging. Additionally, losing their children through the child welfare system was described as punitive and placed them at greater risk for relapse and overdose. CONCLUSIONS A life-course theory approach to examining maternal opioid-related morbidity and mortality in Texas, United States reveals the complex needs of women at risk for opioid use relapse and overdose and the significant role of previous traumatic experiences.
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Affiliation(s)
- Lisa M. Cleveland
- School of NursingThe University of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Kelly McGlothen‐Bell
- School of PharmacologyThe University of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Leticia A. Scott
- School of NursingThe University of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Pamela Recto
- School of NursingThe University of Texas Health Science Center at San AntonioSan AntonioTXUSA
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20
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Care of the Infant and Family Affected by Neonatal Abstinence Syndrome (NAS) Across Multiple Settings. Adv Neonatal Care 2020; 20:347-348. [PMID: 32868582 DOI: 10.1097/anc.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Recto P, McGlothen-Bell K, McGrath J, Brownell E, Cleveland LM. The Role of Stigma in the Nursing Care of Families Impacted by Neonatal Abstinence Syndrome. Adv Neonatal Care 2020; 20:354-363. [PMID: 32868585 PMCID: PMC7467149 DOI: 10.1097/anc.0000000000000778] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current US opioid crisis has resulted in a significant increase in opioid use disorder among pregnant and parenting women. Substance use disorders, in general, are highly stigmatized conditions. Stigma serves as a well-documented global barrier to health-seeking behaviors and engagement in healthcare. While extensive research exists on the stigma of mental illness, few studies have explored the stigma experienced by families impacted by neonatal abstinence syndrome (NAS). PURPOSE Therefore, the purpose of this article is to explore the role of stigma in the care of families impacted by NAS. METHODS In this article, we present a discussion about the effects of stigma on this patient population and provide exemplars of stigma experiences from our previous research and the existing literature. FINDINGS/RESULTS Mothers of infants with NAS faced the challenges of overcoming stigma as they were often ostracized, excluded, and shamed. Nurses who provide care for these women and their infants have reported experiencing ethical distress, moral distress, and compassion fatigue. IMPLICATIONS FOR PRACTICE Greater awareness of the impact of opioid use on the maternal-child population has resulted in numerous educational offerings for healthcare providers; however, this alone is not adequate to end stigma. Fortunately, promising tools and methods have been developed for assisting nurses with addressing stigma in a manner that can be both nonconfrontational and highly effective. IMPLICATIONS FOR RESEARCH Future research is needed to explore and evaluate the efficacy of various existing strategies for counteracting harmful stigma in this patient population.
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Affiliation(s)
- Pamela Recto
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Kelly McGlothen-Bell
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Jacqueline McGrath
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Elizabeth Brownell
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Lisa M. Cleveland
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
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22
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Sex and Gender Interactions on the Use and Impact of Recreational Cannabis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020509. [PMID: 31947505 PMCID: PMC7014129 DOI: 10.3390/ijerph17020509] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 02/06/2023]
Abstract
Cannabis is the second most frequently used substance in the world and regulated or legalized for recreational use in Canada and fourteen US states and territories. As with all substances, a wide range of sex and gender related factors have an influence on how substances are consumed, their physical, mental and social impacts, and how men and women respond to treatment, health promotion, and policies. Given the widespread use of cannabis, and in the context of its increasing regulation, it is important to better understand the sex and gender related factors associated with recreational cannabis use in order to make more precise clinical, programming, and policy decisions. However, sex and gender related factors include a wide variety of processes, features and influences that are rarely fully considered in research. This article explores myriad features of both sex and gender as concepts, illustrates their impact on cannabis use, and focuses on the interactions of sex and gender that affect three main areas of public interest: the development of cannabis use dependence, the impact on various routes of administration (ROA), and the impact on impaired driving. We draw on two separate scoping reviews to examine available evidence in regard to these issues. These three examples are described and illustrate the need for more comprehensive and precise integration of sex and gender in substance use research, as well as serious consideration of the results of doing so, when addressing a major public health issue such as recreational cannabis use.
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23
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Fernandez-Montalvo J, López-Goñi JJ. Profiles of mothers who seek treatment for substance use disorders in a clinical centre. ADVANCES IN DUAL DIAGNOSIS 2019. [DOI: 10.1108/add-08-2019-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to explore the prevalence and profile of mothers among women who sought treatment for drug addiction, as well as the therapeutic progression of these patients.Design/methodology/approachA sample of 180 Spanish women with addiction problems was assessed. Information was collected on the patients’ socio-demographic characteristics, consumption variables and psychological symptoms.FindingsOf the total sample, 22.2 per cent (n= 40) of the women seeking treatment for substance use disorder were mothers. Compared with women without children, mothers scored significantly higher on several EuropASI and psychological variables. Specifically, mothers presented with more medical problems, worse employment/financial situations, and more severity in alcohol use. Moreover, having a history of lifetime physical and/or sexual abuse was related to belonging to the group of mothers. Regarding therapeutic progression, no statistically significant differences in the retention rate were found between mothers and non-mothers.Originality/valueThe results of this study show that mothers generally have more severe problems than non-mothers. Therefore, comprehensive, continuum-based, and client-centred care for mothers is paramount for effective treatment in mothers. The implications of these results for further research and clinical practice are discussed.
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Trying to Do What Is Best: A Qualitative Study of Maternal-Infant Bonding and Neonatal Abstinence Syndrome. Adv Neonatal Care 2019; 19:E3-E15. [PMID: 31166199 DOI: 10.1097/anc.0000000000000616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The maternal experience of caring for and bonding with infants affected by neonatal abstinence syndrome (NAS) has not been adequately characterized. PURPOSE This study was designed to describe mothers' experiences of, supports for, and barriers to bonding with infants with NAS. METHODS Semistructured interviews were coded using computer-assisted thematic content analysis. A code co-occurrence model was used to visualize the relationships between themes. RESULTS Thirteen mothers of infants with NAS participated. Trying to Do What Is Best emerged as the overarching theme with which several subthemes co-occurred. Subthemes that captured mothers loving their infants and bonding, feeling supported by the infants' fathers, feeling supported in the community, and receiving information from hospital staff were associated with mothers' trying to do what is best. Barriers to trying to do what is best included feeling unsupported in the community, guilt about taking medications or substances during pregnancy, feeling judged, and infant withdrawal. IMPLICATIONS FOR PRACTICE Specific implications for practice may be derived from the mothers' criticisms of NAS assessment tools. Mothers highlighted the value of reassurance and education from providers and the uniquely nonjudgmental support received from peers and male coparents. IMPLICATIONS FOR RESEARCH There is a lack of information about maternal-infant bonding in dyads affected by NAS and factors that contribute to parental loss of custody. Qualitative, quantitative, and mixed-methods studies in diverse populations might help researchers better understand the long-term outcomes of NAS and develop interventions that decrease family separation.
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Waddell N, Karatzias T. The relationship between interpersonal trauma and substance misuse in pregnancy. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/bjom.2019.27.9.578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BackgroundThere is a strong body of evidence supporting associations between interpersonal trauma (IPT) and substance use; however, this tends to focus on associations between childhood trauma and substance use in non-pregnant populations. Neonatal and obstetric outcomes are poorer among pregnant women with problematic substance use, yet few studies have explored IPT as a possible mechanism underlying their use of substances.AimTo explore the literature regarding the relationship between IPT and substance misuse among pregnant women.MethodA systematic search of relevant databases was conducted and a narrative review of the literature was undertaken. Titles, abstracts and full articles were screened against inclusion criteria. Data were extracted and quality assessed.FindingsA total of 15 studies were identified that suggested associations between negative life events and substance misuse in pregnant women/new mothers.ConclusionsAlthough a link between IPT and substance misuse is suggested, this review has highlighted a number of important gaps in the literature that warrant further investigation. These include a paucity of UK-based studies, and a lack of research that fully explores possible associations between IPT and substance use in pregnant women. Moreover, research to date has employed quantitative methodology.
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Affiliation(s)
- Naomi Waddell
- Midwifery Lecturer/Researcher, School of Health and Social Care, Edinburgh Napier University
| | - Thanos Karatzias
- Professor and Director of Research, School of Health and Social Care, Edinburgh Napier University
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Whalen BL, Holmes AV, Blythe S. Models of care for neonatal abstinence syndrome: What works? Semin Fetal Neonatal Med 2019; 24:121-132. [PMID: 30926259 DOI: 10.1016/j.siny.2019.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Opioid use disorders and the prescription of long-acting medications for their treatment have increased dramatically over the last decade among pregnant women. Newborns who experience prolonged in utero opioid exposure may develop neonatal abstinence syndrome (NAS). Until recently, much of the focus on improving care for NAS has been on pharmacologically-based care models. Recent studies have illustrated the benefits of rooming-in and parental presence on NAS outcomes. Single center Quality Improvement (QI) initiatives demonstrate the benefits of non-pharmacologic care bundles and symptom prioritization in decreasing the proportion of infants pharmacologically treated and length of hospital stay. Little remains known about the impact of these varied cared models on maternal-infant attachment and mental health. In this review article, we will propose an optimal model of care to improve short- and long-term outcomes for newborns, their mothers and families, and perinatal care systems.
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Affiliation(s)
- Bonny L Whalen
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Dartmouth-Hitchcock Medical Center, DHMC Pediatrics, One Medical Center Dr., Lebanon, NH, 03756, USA.
| | - Alison V Holmes
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Dartmouth-Hitchcock Medical Center, The Dartmouth Institute, DHMC Pediatrics, One Medical Center Dr, Lebanon, NH, 03756, USA.
| | - Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University, Translational Health Research Institute (THRI), Locked Bag 1797, Western Sydney University, Penrith, NSW, 2751, Australia.
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27
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Bogen DL, Whalen BL. Breastmilk feeding for mothers and infants with opioid exposure: What is best? Semin Fetal Neonatal Med 2019; 24:95-104. [PMID: 30922811 DOI: 10.1016/j.siny.2019.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
With rare exception, breastfeeding is the optimal way to feed infants, and has special benefits for women and infants with perinatal opioid exposure. Infants breastfed and/or fed their mother's own breastmilk experience less severe opioid withdrawal symptoms, have shorter hospital stays, and are less likely to be treated with medication for withdrawal. The specific impact of mothers' milk feeding on opioid withdrawal may be related to the act of breastfeeding and associated skin-to-skin contact, qualities of breastmilk, healthier microbiome, small amounts of opioid drug in breastmilk, or a combination of these. Women with opioid use disorder face significant breastfeeding obstacles, including psychosocial, behavioral, concomitant medications, and tobacco use and thus may require high levels of support to achieve their breastfeeding goals. They often don't receive information to make informed infant feeding decisions. Hospital practices such as prenatal education, rooming-in and having a policy that minimizes barriers to breastfeeding are associated with increased breastfeeding rates.
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Affiliation(s)
- Debra L Bogen
- University of Pittsburgh School of Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, 3414 Fifth Ave, Pittsburgh, PA, 15213, USA.
| | - Bonny L Whalen
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Dartmouth-Hitchcock Medical Center, DHMC Pediatrics, One Medical Center Drive, Lebanon, NH, 03756, USA.
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Paterno MT, Low M, Gubrium A, Sanger K. Mothers and Mentors: Exploring Perinatal Addiction and Recovery Through Digital Storytelling. QUALITATIVE HEALTH RESEARCH 2019; 29:545-556. [PMID: 29871558 DOI: 10.1177/1049732318777474] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Substance use disorders (SUDs) are a growing problem for pregnant and parenting women. Woman-to-woman peer support may positively influence perinatal outcomes but little is known about the impact of such support on the women who are providing support. The purpose of this study was to describe experiences of addiction in pregnancy, recovery, and subsequently serving as a peer mentor to other pregnant women with active SUD among women in recovery in a rural setting. We conducted one digital storytelling workshop with five women serving as peer mentors with lived experience of perinatal SUD. The mentors faced significant stigma in pregnancy. They had each done the "inside work" to achieve recovery, and maintained recovery by staying balanced. Peer mentoring supported their own recovery, and story sharing was integral to this process. Peer-led support models may be an effective, self-sustaining method of providing pregnancy-specific peer support for SUD.
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Affiliation(s)
- Mary T Paterno
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Maud Low
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Aline Gubrium
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Kirk Sanger
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
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29
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McGlothen KS, Cleveland LM, Gill SL. "I'm Doing the Best That I Can for Her": Infant-Feeding Decisions of Mothers Receiving Medication-Assisted Treatment for an Opioid Use Disorder. J Hum Lact 2018; 34:535-542. [PMID: 29324188 DOI: 10.1177/0890334417745521] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several professional health organizations have made statements endorsing the safety of breastfeeding for women taking medication-assisted treatment for an opioid use disorder. Yet, breastfeeding initiation rates for this population are approximately 50% lower than the general United States' population. Furthermore, little is known about what influences the infant-feeding decisions of these women. Research aim: This study aimed to describe what influences the infant-feeding decisions of women taking medication-assisted treatment for an opioid use disorder. METHODS Qualitative description was used. We conducted semistructured, individual interviews with mothers ( N = 8) who were receiving medication-assisted treatment during the postpartum period. We analyzed our data using thematic analysis. RESULTS We identified two themes: (a) what I heard about breastfeeding, and (b) doing what I feel is best for my baby. What I heard about breastfeeding reflects the information and misinformation that women received about breastfeeding. Doing what I feel is best for my baby describes the inner conflict that the women experienced. Most of the women in this study desired to breastfeed; however, all women reported that the social stigma surrounding methadone use strongly influenced their infant-feeding decision. CONCLUSION This study sheds new light on what influences the infant-feeding decisions of women taking medication-assisted treatment and represents an initial step toward the development of targeted interventions to improve breastfeeding rates for this unique population.
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Affiliation(s)
- Kelly S McGlothen
- 1 School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Lisa M Cleveland
- 1 School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sara L Gill
- 1 School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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30
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Kramlich D, Kronk R, Marcellus L, Colbert A, Jakub K. Rural Postpartum Women With Substance Use Disorders. QUALITATIVE HEALTH RESEARCH 2018; 28:1449-1461. [PMID: 29651928 DOI: 10.1177/1049732318765720] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The incidence of perinatal opioid use and neonatal withdrawal continues to rise rapidly in the face of the growing opioid addiction epidemic in the United States, with rural areas more severely affected. Despite decades of research and development of practice guidelines, maternal and neonatal outcomes have not improved substantially. This focused ethnography sought to understand the experience of accessing care necessary for substance use disorder recovery, pregnancy, and parenting. Personal accounts of 13 rural women, supplemented by participant observation and media artifacts, uncovered three domains with underlying themes: challenges of getting treatment and care (service availability, distance/geographic location, transportation, provider collaboration/coordination, physical and emotional safety), opportunities to bond (proximity, information), and importance of relationships (respect, empathy, familiarity, inclusion, interactions with care providers). Findings highlight the need for providers and policy makers to reduce barriers to treatment and care related to logistics, stigma, judgment, and lack of understanding of perinatal addiction.
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Affiliation(s)
| | - Rebecca Kronk
- 1 Duquesne University, Pittsburgh, Pennsylvania, USA
| | | | | | - Karen Jakub
- 1 Duquesne University, Pittsburgh, Pennsylvania, USA
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Changing Neonatal Nurses' Perceptions of Caring for Infants Experiencing Neonatal Abstinence Syndrome and Their Mothers: An Evidenced-Based Practice Opportunity. Adv Neonatal Care 2018; 18:128-135. [PMID: 29595550 DOI: 10.1097/anc.0000000000000476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neonatal intensive care units (NICUs) are caring for an increasing number of infants born with neonatal abstinence syndrome (NAS). The literature identifies the need for education for NICU nurses on NAS including skills for interacting with the mother with substance use disorder. PURPOSE An evidence-based practice project was developed to offer an educational presentation targeting these topics to 206 NICU participants (93% registered nurses, 1% licensed vocational nurses, and 6% nursing assistants) at a level IV NICU. METHODS A pretest/posttest was developed to assess knowledge of the participants prior to and after completion of the educational presentation. A posteducational questionnaire was developed to evaluate the skills learned for interacting with the mother with substance use disorder and the participant's professional readiness. RESULTS The posttest demonstrated a statistically significant (P < .001) increase in knowledge of NAS. On the post-educational questionnaire, 96% of participants correctly identified 3 skills they would use clinically with mothers with substance use disorder and 84% of participants identified 2 personal strengths and 2 weaknesses that influence their care of infants with NAS and their families (professional readiness). IMPLICATIONS FOR PRACTICE These results demonstrate that this educational presentation was effective and should be replicated at other facilities to improve the knowledge and skills of NICU nurses to promote improved care for infants with NAS. IMPLICATIONS FOR RESEARCH Future studies should examine the impact on patient outcomes by preforming post-discharge interviews with the mothers of infants with NAS in the NICU pre- and post-educational intervention. Expanding the presentation into an interprofessional educational opportunity would promote increased knowledge and care by the entire multidisciplinary team.
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Abstract
Shame is a universal living experience that is just beginning to be explored within the discipline of nursing. Development of a broad understanding of shame is needed to aid nurse researchers in clarifying this phenomenon from a nursing perspective. Pursuant to this goal, the author in this article reviews the extant literature on shame from the disciplines of nursing, psychology, sociology, philosophy, and theology. Three themes that emerged from the scholarly literature were (a) shame propels miring in paralysis, (b) shame captures the illusionary seen-unseen, and
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Affiliation(s)
- Molly J Shaughnessy
- 1 Decker School of Nursing, Binghamton University, State University of New York, Oneonta, NY, USA
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