PC1123: Understanding the Early Parenting Experiences of Mothers with Opioid Use Disorder

Background: The period after delivery is a critical time for mother-infant dyads. Early bonding is associated with improved infant social-emotional development, executive functioning, long-term mental health and resilience of children, and also impacts maternal mental health and well-being. This qualitative study aims to elucidate the impact of opioid use disorder (OUD), hospital care and follow-up for infants at risk for neonatal opioid withdrawal syndrome (NOWS) on early parenting experiences among a cohort of postpartum women.

Methods: We drew from a qualitative study investigating facilitators and barriers to using medications to treat OUD in the perinatal period with additional prompts exploring relationships between early parenting experiences, addiction and recovery experiences. Eligible participants were those with OUD and a live birth within three years, largely identified through medical record review at a multidisciplinary OUD postpartum clinic in Boston, MA. Interviews occurred between 10/2019-12/2020 and lasted 30-90 minutes, were audio-recorded, transcribed verbatim by an outside transcription service, and deidentified for analysis. Recruitment continued until no new codes emerged and thematic saturation occurred. A constant comparative methods approach was utilized, with an iterative process of reviewing data collected, analyzing codes, and updating interview questions to refine themes. NVivo Qualitative software was used to evaluate transcripts using the coding scheme developed.

Results: 26 women (mean age = 33) were consented and interviewed, representing broad demographic of racial, socioeconomic and OUD background. Several qualitative themes were noted: Mothers experienced the period following delivery as one of surveillance by hospital staff who doubted their parenting abilities, disrupting their trust in the medical system. Desires for a “normal” early pregnancy experience and recognition of parenting strengths are often disrupted by ramifications of NOWS, including prolonged hospitalization, mandatory child welfare reporting, labeling in the medical record, and monitoring for developmental delay. Participants with OUD highlight their intertwined identities as person in recovery and mother as informing goals and best supports for their families.

Conclusion: This exploratory analysis emphasizes challenges mothers with OUD face during the early parenting period and suggests potential avenues for interventions to improve their experiences in the medical system while encouraging recovery and growth as new parents. Further work should focus on reducing perceptions of stigma for children and parents impacted by OUD, building trust between families and healthcare teams, returning central focus to “normal” early childhood experiences and needs and facilitating programs to provide supports identified as most useful by families themselves rather than outside parties.