Birthcare Healthcare, University of Utah, Salt Lake City, Utah.
College of Nursing, University of Utah, Salt Lake City, Utah.
J Midwifery Womens Health. 2019 Sep;64(5):532-544. doi: 10.1111/jmwh.13019. Epub 2019 Aug 12.
Opioid misuse is a problem that is complex and widespread. Opioid misuse rates are rising across all US demographics, including among pregnant women. The opioid epidemic brings a unique set of challenges for maternity health care providers, ranging from ethical considerations to the complex health needs and risks for both woman and fetus. This article addresses care for pregnant women during the antepartum, intrapartum, and postpartum periods through the lens of the opioid epidemic, including screening and counseling, an interprofessional approach to prenatal care, legal considerations, and considerations for care during labor and birth and postpartum. Providers can be trained to identify at-risk women through the evidence-based process of Screening, Brief Intervention, and Referral to Treatment (SBIRT) and connect them with the appropriate care to optimize outcomes. Women at moderate risk of opioid use disorder can be engaged in a brief conversation with their provider to discuss risks and enhance motivation for healthy behaviors. Women with risky opioid use can be given a warm referral to pharmacologic treatment programs, ideally comprehensive prenatal treatment programs where available (a warm referral is a term used when a provider, with the patient's permission, contacts another provider or another service him or herself rather than providing a phone number and referral number). Evidence regarding care for the pregnant woman with opioid use disorder and practical clinical recommendations are provided.
阿片类药物滥用是一个复杂且广泛存在的问题。阿片类药物滥用率在美国所有人群中都在上升，包括孕妇。阿片类药物泛滥给产妇保健提供者带来了一系列独特的挑战，从伦理问题到妇女和胎儿的复杂健康需求和风险。本文从阿片类药物泛滥的角度探讨了产前、产时和产后期间孕妇的护理，包括筛查和咨询、产前护理的跨专业方法、法律问题以及分娩和产后护理的注意事项。通过基于证据的筛查、简短干预和转介治疗（SBIRT），可以培训提供者识别有风险的妇女，并将她们与适当的护理联系起来，以优化结果。对于有中度阿片类药物使用障碍风险的妇女，可以与提供者进行简短的对话，讨论风险并增强健康行为的动机。对于有风险的阿片类药物使用者，可以给予他们一个温暖的转介到药物治疗计划，理想情况下是在有条件的情况下提供综合产前治疗计划（温暖转介是指提供者在获得患者同意的情况下，自行联系另一位提供者或服务提供者，而不是提供电话号码和转介号码）。本文提供了关于阿片类药物使用障碍孕妇护理的证据和实用的临床建议。
