Maternity providers' moral experiences addressing maternal drug use

Area of Science:

• Medical Ethics
• Maternal Health
• Substance Use Disorders

Background:

• Caring for pregnant and postpartum women who use drugs (PPWUD) involves complex ethical, social, and legal considerations.
• The moral experiences of healthcare providers in this area are not well understood.
• Existing frameworks often do not adequately address the interplay between maternal and child welfare.

Purpose of the Study:

• To synthesize qualitative literature on the moral experiences of maternity providers caring for PPWUD.
• To focus specifically on ethical challenges related to drug testing and child welfare reporting.
• To identify factors influencing provider moral distress in this population.

Main Methods:

• Systematic literature search of PubMed, PsycINFO, and CINAHL.
• Quality assessment using the Joanna Briggs Institute Critical Appraisal Checklist.
• Thematic narrative analysis guided by the Hunt and Carnevale bioethics framework.

Main Results:

• Maternity providers experience significant ethical conflicts stemming from provider-level and policy-level factors.
• While respecting patient autonomy, providers do not condone substance use posing risks to the fetus or child.
• Healthcare system constraints and punitive laws act as barriers to optimal PPWUD care.
• Drug testing protocols and child welfare policies create conflicts between provider-patient relationships and reporting duties.

Conclusions:

• Moral experiences of maternity providers are shaped by systemic and policy-level issues.
• Interventions and policy reforms are needed to support providers caring for PPWUD.
• Addressing ethical conflicts in drug testing and reporting is crucial for improving care for mothers and children.