Examining How Birth Professionals Define and Apply Perinatal Harm Reduction, Their Practice Motivations, and the Values That Shape Their Understanding of Perinatal Harm Reduction As a Care Movement

Background: Up to 10% of birthing people use substances during the perinatal period (McCance-Katz, 2020; Rodriguez & Smith, 2019). The resulting criminalization and isolation of these birthing people has resulted in a public health crisis of birthing person overdose and family separation (Han et al., 2024; Jarlenski et al., 2021). Harm reduction interventions, such as medications for opioid use disorder (MOUD), non-pharmacological Neonatal Withdrawal Syndrome care, and integrated perinatal and substance use care, are already being used in perinatal settings (Goodman et al., 2022; Grisham et al., 2019; Krans et al., 2021). Still, those who could benefit from MOUDs and other interventions do not have consistent access or cannot overcome other barriers to substance use treatment (Amato et al., 2011; Clemans-Cope et al., 2019; Terplan et al., 2015). Besides interventions such as MOUD care and Eat, Sleep, Console (ESC), how harm reduction is implemented during the perinatal period is understudied but has inordinate potential to improve birth outcomes and decrease family separation.

Significance: How birth professionals influence health outcomes for birthing people who use substances through incorporating perinatal harm reduction (PHR) is missing from extant academic literature. This paper seeks to briefly define perinatal harm reduction through the perspective of birth professionals who identify as doing this work. This paper examines how these birth professionals apply PHR in everyday interactions with birthing people. Through examining four settings in which PHR is applied, the birth professionals illustrate how to integrate values-based practice in the face of systemic and institutional barriers that criminalize their patients.

Methods: This research utilizes 16 semi-structured interviews with birth workers, peer navigators, and perinatal workforce providers, analyzed through thematic analysis (Braun & Clarke, 2006). Additionally, this paper focuses on four practice settings where perinatal harm reduction is applied. Participants who practiced in one of the four settings were grouped together to provide context on policies that impede their work and how they navigate the praxis of PHR.

Findings: Findings are separated into four main themes: definition of PHR, motivations for incorporating harm reduction into perinatal practice, values that shape PHR, and the application of perinatal harm reduction. Participants defined perinatal harm reduction as profoundly values-based and identified critical motivational pathways for adopting harm reduction in their practice. Additionally, four practice setting cases are presented: a standalone Eat, Sleep, Console nursery; a buprenorphine clinic; incarcerated setting; and birth work (doulas) are used to highlight multiple participants’ experiences of applying PHR. The ESC nursery (3 participants) and buprenorphine clinic (4 participants) present cases of specific workplaces and how institutional policies affect practice. Birth work (3 participants) and incarcerated settings (2 participants) are used to illustrate how systemic policies and the criminalization of perinatal substance use shape practice across multiple states, mostly through the family regulation system.

Future Implications: By defining and understanding the application of PHR, birth professionals can more uniformly implement harm reduction with this population. Future research can use the birth professional-informed definition of perinatal harm reduction to evaluate this approach and its influence on birth outcomes.