A Qualitative Assessment of Healthcare Experiences and Perceptions Among Pregnant
and Postpartum Women with a History of Drug Use

Author: Alexandra Ranucci, BS, MS4, Department of Obstetrics and Gynecology, Tulane School of Medicine, New Orleans, LA
Co-Authors: Alexandra Ranucci, Jinnesse Taylor, Clara Wynn,
Department of Obstetrics and Gynecology, Tulane University School of Medicine

Knowledge Gap: Women who use illicit drugs during pregnancy are often faced with the difficult decision  whether or  not to seek prenatal care that will likely include drug screening and subsequently reveal illegal  substance use. We believe clinician actions and implicit biases during initial encounters with pregnant  women who use drugs have the ability to greatly impact this decision. Our study aims to better  understand the factors that encourage or dissuade these women from seeking prenatal care and  ultimately disclosing their substance use. Additionally, we aim to elicit women’s perceptions of  clinician actions after learning of their drug use, with suggestions for clinician improvement when  treating this population.

Design: We recruited 11 women from two Louisiana drug rehabilitation centers who were pregnant or gave  birth within the past two years and reported drug use during that pregnancy. We utilized semi‐ structured qualitative interviews, and collected lifetime drug use and pregnancy histories and basic  demographics. Using NVivo software, three independent research team members have begun to  conduct in‐depth analysis to identify interview themes using an exploratory approach. Consensus  building rounds will occur to resolve discordant coding.

Findings: Based on preliminary interview coding, a variety of factors were identified as contributing to a  woman’s reluctance to seek prenatal care, including: perception of judgement from clinicians, fear of  DCFS intervention and child separation, and drug addiction and the need to use superseding other  priorities like accessing healthcare. Recommendations for providers included the need for clinicians to  address drug use more directly, explicitly asking if treatment was desired as well as any other social  factors impacting their drug use and pregnancy.

Implications: In response to these themes, our preliminary recommendations include: improved training to  mitigate clinician implicit bias specifically when providing prenatal care to women using drugs, and  education regarding the full scope of substance use treatment options available to patients in order to improve clinician comfort in directly addressing substance use with evidence based treatment.

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