Navigating recovery: a scoping review of comprehensive approaches to postpartum substance use care and support

Unregulated drug use, including non-prescription opioids, is a growing public health problem in Canada and the United States, compounded by a toxic drug supply and rising overdose rates. Perinatal women, particularly in the postpartum period, face increased risks, with overdose now a leading cause of maternal mortality. Despite these risks, research has largely focused on substance use during pregnancy, with limited attention to the postpartum period. Understanding the experience of postpartum women who use unregulated drugs and/or non-prescription opioids, including their recovery experience, is essential for designing supportive care. Therefore, the purpose of this scoping review was to map the current body of evidence on the experiences of postpartum women with a history of unregulated drug and/or non-prescription opioid use, including their recovery experiences where reported.

This scoping review used Arksey and O'Malley's five-step framework to systematically map the available literature. A search of six databases and relevant websites was used to identify primary research published between 2013 and 2024. The articles were screened using defined inclusion and exclusion criteria and thematic analysis was used to identify key themes.

The analysis of 11 studies that met the inclusion criteria resulted in the identification of four themes related to the experience of recovery: (1) Positive and negative aspects of diverse relationships, (2) The pivotal role of motherhood and the mother-child bond, (3) Cultivating self-related factors, and (4) Navigating barriers and seeking support for improved health outcomes.

Substance use recovery during the postpartum period is shaped by both external relationships and self-related factors. Recovery programs that support women in navigating diverse relationships while also fostering internal factors such as self acceptance, self-efficacy, and resilience are needed. Access to comprehensive, integrated care is essential, particularly care that prioritizes keeping mothers and children together and includes peer support.