"I'm Treated like a Human": Perceptions of Mothers in Substance Use Recovery on Postpartum Care Received at Specialized Perinatal and Pediatric Medical Homes

Background and Purpose: The number of children born to women with opioid/substance use disorder (OUD/SUD) has more than doubled since 2010 (Hirai et al., 2021). For maternal-infant dyads managing substance use recovery, the postpartum year is a vulnerable period, with elevated risks of relapse, overdose, death, family dissolution and trauma (Schiff et al., 2018). Women with OUD/SUD often have complex trauma, co-occurring mental health disorders and other psychosocial stressors which may compromise recovery and challenge parenting (Paris et al., 2023). Although medical providers offer services to children with in-utero substance exposure, few clinics provide comprehensive wraparound care for this population (Schiff et al., 2024; Stulac et al., 2024). Furthermore, pregnant and postpartum women with OUD/SUD have reported bias and stigma from healthcare providers resulting in reduced engagement (Paris et al., 2020). To address these concerns, this study’s goal was to describe maternal participants’ perceptions of care in perinatal and pediatric medical homes and to identify the ways programs support families during the postpartum year. The setting for the study was a large urban safety-net hospital in the Northeast with a specialized perinatal clinic for individuals with SUDs and a pediatric medical home for impacted children. Both programs embraced wraparound models, including integrated SUD and mental health treatment, and case management services. They are each led by social workers in the clinic manager role who oversee the assessment of patient needs and coordination of care.

Methods: Interview data were analyzed from a prospective longitudinal community-engaged qualitive study of postpartum mothers receiving care at one or both of the medical homes (N=24; M age= 33 years; 75% white; 58% partnered; 83% income < $20,000) with OUD/SUD (83% taking MOUD in pregnancy). The interview guide, developed collaboratively with a mother in long-term recovery, asked about current parenting experiences, recovery, strengths/supports, and challenges at three timepoints over the postpartum year. Audiotaped interview transcripts were coded and analyzed using thematic analysis by two research assistants supervised by the study’s PIs.

Findings: Participants consistently reported positive views of the medical homes across timepoints. Four themes were identified regarding experiences with staff (social workers, patient navigators, recovery mentors, and medical providers): 1) lack of judgment/stigma; 2) positive communication; 3) accessible lines of communication; and 4) sustained relationships. The types of support received from the medical homes included: 1) parenting support; 2) recovery support; 3) resource /referral provision; 4) advocacy; and 5) social support.

Conclusion and Implications: The perinatal and pediatric medical homes were perceived as key sources of support during the postpartum year. Findings highlight the importance of nonjudgmental, relationship-centered care in fostering trust and engagement among families impacted by OUD/SUD. The breadth of ancillary services provided demonstrates the value of comprehensive wraparound programs managed by social workers in supporting early parenting and recovery needs. To facilitate replication of this specialty wraparound model, future research should examine the perspectives of wraparound clinic staff on program structure, role coordination, implementation, and patient care outcomes.