New Models of Care Are Needed for Pregnant and Parenting Women With OUD to Reduce Avoidable Pregnancy-Associated Deaths
In April 2021, the Centers for Disease Control and Prevention released its 2019 maternal mortality data,1 which showed deaths during pregnancy or within 42 days of the end of pregnancy increased 14.5% from the year before in the US. During this same period, maternal mortality rates declined worldwide.2 Pregnancy-associated deaths involving opioids have more than doubled between 2007 and 2016.3 Although treatment for opioid use disorder (OUD) during pregnancy is known to improve maternal and neonatal health outcomes, only one third of pregnant women with OUD receive medications for opioid use disorder (MOUD).4 In addition, while overdose death rates have increased for both men and women across the nation, the increase among women outpaces that among men.5
Traditional treatment programs that offer medication, therapy, and wraparound services, including support finding housing and employment, often fail to address women's particular needs,6 which may explain why women are less likely to enter treatment than men.7 Pregnancy itself can also be a barrier to treatment when programs do not admit pregnant people or provide the services they require, such as childcare assistance, prenatal care, parenting training, and supportive services to address domestic violence, sexual trauma, and other forms of victimization.8
In response to this growing need, targeted interventions have begun to emerge to deliver information and services for pregnant and parenting people. Through grantmaking, the Foundation for Opioid Response Efforts (FORE) has worked to support and strengthen evidence-based programs for pregnant and parenting people and their families in the following ways:
- To provide holistic care, FORE provided funding to launch the Don't Quit the Quit program, run by the University of North Dakota, which aims to increase access to MOUD for pregnant, parenting, and breastfeeding women with OUD in rural and tribal communities. The program offers education and technical support from a board-certified physician in psychiatry and addiction medicine to physicians, nurse practitioners, physician assistants, and nurse midwives as well as webinars on topics such as breastfeeding on MOUD and neonatal abstinence syndrome. Leaders also encourage clinicians to pursue the waiver for prescribing buprenorphine. They have partnered with Women, Infants, and Children (WIC) offices in an 8-county region to increase staff knowledge of OUD and local treatment options, so the staff members can then help mothers who visit these offices find OUD services. The program is also training community members to work as postpartum doulas; the doulas provide education about infant care and feeding, help new mothers with household tasks, and seek to increase their confidence as they transition to parenthood.
- To meet women where they are, FORE supports Renewal House, the only long-term, residential substance use disorder treatment program for pregnant and parenting women in Middle Tennessee. Renewal House launched a free treatment group via telehealth that offers help in reducing substance use and increasing parenting skills. The program is offered to women who are currently in or have graduated from residential and outpatient programs and those who are on the waiting list for services. The telehealth platform reduces barriers to accessing care, such as having to find childcare, transportation, and other costs associated with attending in-person meetings while creating a supportive space for women to learn and recover together.
- To provide support for women at high risk and their families, FORE funded Jenna's Project, a pilot program developed by UNC Horizons, a substance use disorder treatment program for pregnant and parenting women affiliated with the University of North Carolina School of Medicine's Department of Obstetrics and Gynecology. Jenna's Project seeks to ensure women leaving prison don't experience disruptions in OUD treatment and helps them secure housing and reunite with their families, using a trauma-informed model of care that aims to heal ruptures between mothers and their children. In addition, the UNC Horizons team has been able to expand to offer services to pregnant women while they are still in the North Carolina Correctional Institute for Women (NCCIW).9 Jenna’s Project has enabled the prison to expand psychiatric and other mental health services with a behavioral health team from UNC Horizons now working alongside the NCCIW clinic staff to address the intersectionality of substance use, pregnancy, trauma, and incarceration. UNC Horizons also provides residential treatment for women with OUD, following a holistic approach by addressing women’s medical and mental health needs and offering them support finding childcare, employment, and housing.
In the United States, approximately 60% of pregnancy-related death is preventable.10 With drug overdose deaths as the highest risk of pregnancy-related mortality,11 comprehensive care is sorely needed to address the impact of the opioid crisis on pregnant and parenting people. In addition to supporting these programs, FORE seeks to build the evidence base of what works for this population so that they can be scaled across the US, promoting recovery and more stable lives for parents and children.
-Lydia Tschoe, MHA, and Karen A. Scott, MD, MPH
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The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of the Psych Congress Network or the Psychiatry & Behavioral Health Learning Network or other Network authors. Blog entries are not medical advice.
