Patient-Reported Challenging and Promoting Factors for Recovery Through the Postpartum Transition Among Women in Treatment for Opioid Use Disorder

Background: For women with opioid use disorder (OUD), the interplay between the stressors of the fourth trimester on top of those specific to addiction and recovery may be contributing to overdose now being a leading cause of mortality during the postpartum period. A better understanding of what specific factors are leading to these poor outcomes is urgently needed. The objective of this study was to identify patient-reported aspects of the postpartum transition that impact parenting efficacy and recovery among women in treatment for OUD.
Methods: This is a secondary data analysis from an ongoing study to develop and test a patient education tool. Twelve postpartum (< 12 months after delivery) women on medication for OUD were recruited from a specialized clinic providing integrated perinatal and OUD care to complete a semistructured interview. Interview guides were developed a priori based on the study objectives. Interviews were recorded, deidentified and analyzed using the “editing style” approach.
Results: Two major themes were identified: challenging and promoting factors for OUD recovery of the motherinfant dyad through the postpartum transition. A wide array of challenges was reported: lack of parenting knowledge and confidence in taking care of infants at risk of neonatal opioid withdrawal syndrome, mood lability, stigma surrounding OUD medication, fear of child welfare, and pain associated with labor and delivery. Various promoting factors were reported: infant attachment and bonding, consistent OUD medication use, and having a recovery support system of family, medical providers, and other mothers.
Conclusion: Women identify many aspects of the postpartum transition that both challenge and promote continued OUD recovery and parenting efficacy across clinical, psychological, and social domains. Better OUD treatment regimens tailored for postpartum women are needed in the opioid crisis, and patient-reported data should guide these emerging recovery-oriented systems of care for the mother-infant dyad.