October 21, 2019
A Qualitative Assessment of Healthcare Experiences and Perceptions Among Pregnant and Postpartum Women with a History of Drug Use
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.