A Qualitative Study of Neonatal Abstinence Syndrome in Ohio: Implications for Maternal and Child Health Programs

Background and Purpose: The United States has seen an alarming increase in the abuse of opioids, including misuse of prescription opioid medication and transitions to heroin use. In recent years, there has been a significant increase in pregnant women seeking treatment for opioid addiction and mothers giving birth to babies diagnosed with Neonatal Abstinence Syndrome (NAS), in which infants exposed to opioids in utero are born with a constellation of health complications. NAS tripled in incidence from 2000 to 2009 in the U.S. In Ohio, there were 1,691 NAS hospital admissions, or nearly five per day, in 2013 alone. To better understand NAS and inform prevention efforts, we conducted qualitative interviews with healthcare providers and at-risk women.

Methods: We conducted 18 in-depth, key informant interviews with healthcare providers who work first-hand with at-risk women and their infants. Participants were asked about their experience providing services to women and NAS infants and their assessment of the gaps in prevention and treatment of NAS. Additionally, we conducted 28 semi-structured interviews with at-risk women recruited through clinics, treatment facilities, and word of mouth. Women were 1) currently pregnant and on medication assisted therapy (MAT) for opioid use and/or using opioids, or 2) recently delivered a child while on MAT or actively using opioids. Interviews used a life history approach to assess histories of drug use, experiences with opioid treatment and pregnancy, and perceptions of service needs to prevent NAS and promote women’s health. All interviews were transcribed and coded using an inductive approach to identify key themes.

Findings: Key informants were predominantly female (67% female), and included physicians, nurses, social workers, and other healthcare providers. The women were predominantly white (78.6% white, 14.3% African-American, 7.1% other) with average age of 30 (range: 22-41). Key informants and women agreed that NAS is a significant concern in Ohio, but there are few options for preventative care. Once pregnant, many of the women in our sample sought care in newly-established, comprehensive programs where they received MAT (methadone or Suboxone) along with prenatal and mental healthcare. While such programs were perceived as helpful by providers and women, barriers including waitlists, insurance issues, stigma, and travel from rural areas presented challenges for women. Limited follow-up services and lack of coordinated care for families with newborns also presented long-term challenges.

Conclusion and Implications:  Our analysis identified NAS prevention and treatment needs by asking healthcare providers and at-risk women about what would effectively promote maternal and child health. Findings can be used to implement holistic treatment programs for women that address the mental and physical aspects of addiction before, during, and after pregnancy.