Postpartum Parenting for Women in Recovery from Opioid Use Disorder: Life Purpose, Supports and Challenges

Background: The year after delivering a baby is a vulnerable period for maternal-infant dyads in substance use recovery. Short and long-term risks include relapse, overdose, death, family dissolution and trauma (Schiff et al., 2018). Women with opioid use disorder (OUDs) often have family histories of substance misuse, complex trauma, and co-occurring mental health disorders which may compromise their ability to maintain recovery and make parenting challenging (Paris, et al., 2023). Longitudinal supports tailored to women and children in the first year postpartum are needed to address high rates of relapse and mental health difficulties and promote dyadic wellbeing. Even with growing numbers of supportive interventions, including innovative pediatric medical homes for substance-exposed infants and their parents (Stulac, et al., 2019), there continue to be major stressors including poverty, challenges in parenting, separation of infants and mothers, and relapse, among others. To our knowledge, there are no longitudinal qualitative studies of this specific high-risk population over the postpartum year. The aim of this study is to explore the early postpartum period for mothers in recovery regarding 1) parenting experiences, 2) supports utilized, and 3) stressors that could challenge sobriety.

Methods: Time 1 interview data were analyzed from a prospective longitudinal community-engaged qualitive study of postpartum mothers (N=24; M age= 33 years; 80% white; 68% HS/some college; 54% partnered; 83% income < $20,000) with OUD/SUD (majority taking MOUD; M craving score=1.5) whose infants (M age= 5 months) were patients at a pediatric clinic for children exposed to substances in utero. Semi-structured interviews developed collaboratively with a mother in long-term recovery queried participants about current parenting experiences and recovery, received supports, and challenges faced. Transcripts from audiotaped interviews were coded by two research assistants supervised by the study’s PIs (MSW/PhD and MD) using the QDA software NVivo. Analyses used grounded theory techniques (Charmaz, 2014) including line-by-line coding and subsequent creation of concise themes and categories.

Findings: Data analysis of transcripts revealed the complexities of maintaining sobriety while parenting during the initial postpartum period. First, the discovery of unplanned pregnancies prompted the majority of women to seek substance use treatment, motherhood then motivated them to maintain recovery for their infant, and subsequently parenting became the life purpose that kept them sober. Second, large support networks of family, friends, and providers when available, were essential during the first few months after delivery. Finally, although most mothers felt that their recovery was progressing well issues such as inadequate housing, difficulties accessing services, conflict with child welfare, isolation, and mental health challenges remained difficulties for many and were perceived as potential stressors impacting recovery.

Conclusion: Findings highlight that the early postpartum period remains a time of opportunity that is also fraught with challenges for women with OUD. Responding to the voices of these mothers, social workers and other providers must coordinate supports enabling women to safely parent their children and solidify their mothering role. Further research should continue to detail these mothers’ lived experiences to develop culturally responsive multi-disciplinary programs.