"I Was Really Scared to Get Attached": The Postpartum Experiences of Mothers with Opioid Use Disorders and Risk for Relapse

Background and Purpose:

While pregnancy presents a strong motivation to seek and comply with Opioid Use Disorder (OUD) treatment, up to 80% of women relapse to illicit opioid use within six months of childbirth. Moreover, fatal overdoses are now a leading cause of maternal death in the US. The purpose of the present study was to examine the postpartum experiences of mothers with OUDs as it relates to mothers urges to use illicit substances.

Methods: We recruited mothers with a history of OUD and their newborns into the Newborn Attachment and Wellness study (within a NICU in the Southwest US). Participants (N=42, Mage=28.56; SD=5.19) represent the diversity of the region (50% White, 19% Hispanic, 12% BlPOC). Interviews from birth, 3- and 6-months were included in the present study. Mothers described the social, physical, emotional, and psychological experiences surrounding their pregnancy, birth, and first 6 months of infancy. At each wave, participants completed a self-report measure on their strong desire or urge to use various illicit substances. Data were summed to create an urge score, dummy coded, and categorized across each wave: no urges (at any wave), no initial urges (urges at later waves), and urges to use substances (at each wave).

Results: A qualitative content analysis revealed six themes that informed a continuum of risk for relapse. Mothers with no urges described a positive Breastfeeding experience, mothers with no initial urges described challenges breastfeeding (“it was a fight the whole time”), and the majority of mothers with urges did not breastfeed. The Pregnancy experience of mothers with urges was marked by a late discovery and lack of attachment during pregnancy. Recovery Plan: Mothers with no urges or no initial urges were more likely to be prescribed suboxone (buprenorphine/naloxone) compared to mothers with urges (methadone). Mothers with no urges described Birth Experience Support (“we had a lot of support and it was very peaceful”) compared to mothers with no initial urges and urges (“I would have liked to have my partner there”). Mothers with no urges primarily had no DCS Involvement, whereas many with no initial urges had infants placed into DCS care shortly after birth (“I see her 3 times a week, like 2 hours each visit”), and almost all mothers with urges had DCS involvement (“it’s like the longer they’re away from you, the less you feel like a mom”). Finally, the experiences of mothers with urges was noted by explicit statements of challenges with Mental Health (“I’m just disgusted...I lost so much weight where I don’t even care like it doesn’t bother me I look sick. I don’t really care anymore. I know what’s going on with me and I’m just sad, you know? I’m just sad [baby crying]).

Conclusions and Implications: There is a critical window in which social workers have the opportunity to capitalize on mothers’ desire “not to ever want to touch it again”. We outline specific avenues for directed support in the perinatal and postpartum period that is associated with reduced risk for relapse.