Navigating Choices: Pregnancy Options Counseling Experiences in Individuals With Opioid Use Disorder

People with childbearing potential and opioid use disorder (OUD) have high rates of unintended pregnancies. Addiction medicine providers occupy an important role in diagnosing and counseling those who become pregnant; however, no guidelines exist to facilitate these conversations. We sought to explore participant experiences with pregnancy options counseling while in opioid use disorder treatment clinics.

We conducted semistructured interviews with people who became pregnant while in OUD treatment, regardless of pregnancy outcome. The interview domains included (1) interactions with health care upon pregnancy discovery, (2) pregnancy options counseling provision, and (3) factors affecting pregnancy decision. A codebook was formulated through an iterative process using a P3 framework (practice, provider, patient). All interviews were double-coded and analyzed for content and themes.

Eighteen participants completed interviews between December 2022 and April 2023. Participants reported valuing nonjudgmental communication when providers disclose unexpected pregnancy results, as well as the need for unbiased and trustworthy information regarding the impact of OUD and OUD treatment on their options. They also identified the unique stigma and bias experienced by pregnant people with OUD.

Although no guidelines exist to guide pregnancy options counseling in addiction medicine settings, efforts should be made to integrate all pregnancy options counseling-parenting, adoption, and abortion-and/or referrals into the care of pregnant patients at OUD treatment centers. Effective discussions should be conducted in a nonbiased and nonjudgmental fashion. Our findings can be used to develop patient-centered counseling aimed at improving pregnancy decision-making while in treatment for OUD.