From the Division of General Academic Pediatrics, MassGeneral for Children, Boston, MA (DMS, SM, ECW); Division of Newborn Medicine, Mass General for Children, Boston MA (DMS); Division of Newborn Medicine, Brigham and Women's Hospital, Boston, MA (KDLMM); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (BBH); Division of Women's Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA (SFG); Harvard Medical School, Boston, MA (SFG, LS); Department of Pediatrics, Perelman School of Medicine, and Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA (BC); Division of General Pediatrics, PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA (BC); Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts (TEW); and Department of Community Health Sciences, Boston University School of Public Health, Boston, MA (JAB).
J Addict Med. 2024;18(1):55-61. doi: 10.1097/ADM.0000000000001242. Epub 2023 Nov 22.
The aim of the study is to explore the early parenting experiences among a cohort of postpartum individuals with opioid use disorder (OUD) both during and after the delivery hospitalization to identify areas of intervention to strengthen bonding and attachment.
Semistructured qualitative interviews with recently pregnant people with OUD assessed parenting needs, supports, and goals in the context of the demands of addiction treatment and early motherhood. Probes explored the relationship between early parenting experiences, addiction, and recovery, as well as enabling factors and barriers to mother-infant bonding. Interviews were completed between 2019 to 2020. A constant comparative methods approach was used for codebook development and analysis.
Twenty-six women completed interviews a mean of 10.1 months postpartum. Twenty-four women were receiving methadone or buprenorphine treatment at delivery for OUD. Four interrelated themes emerged. Women experienced the following: (1) increased surveillance from healthcare workers who doubted their parenting ability; (2) a desire for a "normal" early parenting experience that was not disrupted by increased medical monitoring and surveillance; (3) complex and intersecting identities of being both a mother and a person in recovery; and (4) the importance of support from and advocacy by clinicians and peers to developing maternal confidence and connection.
Interventions are needed to improve the early parenting experiences of opioid-exposed mother-infant dyads, to address the mutual mistrust between health care providers and parents, and to provide additional supports to families. Promotion of positive attachment and parental self-efficacy should be prioritized over increased surveillance and scrutiny to sustain maternal recovery trajectories into early childhood and foster family well-being.
本研究旨在探讨产后阿片类药物使用障碍（OUD）患者队列在分娩住院期间和之后的早期育儿经历，以确定加强联系和依恋的干预领域。
对最近患有 OUD 的孕妇进行半结构化定性访谈，评估了在成瘾治疗和早期母亲身份需求下的育儿需求、支持和目标。探针探讨了早期育儿经历、成瘾和康复之间的关系，以及母婴联系的促成因素和障碍。访谈于 2019 年至 2020 年期间进行。使用恒定比较方法方法开发和分析代码簿。
26 名女性在产后平均 10.1 个月完成了访谈。24 名女性在分娩时因 OUD 接受美沙酮或丁丙诺啡治疗。出现了四个相互关联的主题。女性经历了以下情况：（1）医护人员增加了对她们育儿能力的怀疑，增加了监测；（2）渴望一个不被增加的医疗监测和监督所打乱的“正常”早期育儿经历；（3）作为母亲和康复者的复杂和交叉身份；（4）临床医生和同行的支持和倡导对培养母亲的信心和联系的重要性。
需要干预措施来改善阿片类药物暴露的母婴对子的早期育儿经历，以解决医护人员和父母之间的相互不信任，并为家庭提供额外的支持。应该优先促进积极的依恋和父母自我效能感，而不是增加监测和审查，以维持母亲的康复轨迹进入幼儿期，并促进家庭的幸福感。
