Expanding evidence-based care for opioid-exposed mother-infant dyads: a mixed-methods study

Prenatal opioid use continues to contribute to rising rates of neonatal opioid withdrawal syndrome (NOWS) and adverse maternal-infant outcomes in the United States. The Managing Abstinence in Newborns (MAiN) 2.0 model was implemented to expand evidence-based, family-centered NOWS care practices across hospitals in South Carolina (SC). This study evaluated the midpoint implementation of MAiN 2.0 by examining maternal and infant outcomes alongside healthcare provider perspectives on implementation facilitators and barriers.

A convergent mixed-methods design was used. Quantitative and qualitative data were collected from opioid-exposed mother-infant dyads and healthcare providers at four rural SC hospitals participating in MAiN 2.0. Quantitative data were used to compare maternal and infant outcomes between the baseline and midpoint implementation periods using independent-samples t-tests and chi-square tests. Outcomes included NOWS severity, length of stay, discharge disposition, prenatal care utilization, rooming-in, and use of supportive services. Semi-structured interviews were conducted with 23 key informants in clinical and healthcare administrative hospital roles. Qualitative data were analyzed using deductive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR). Data were triangulated to contextualize findings.

Significant improvements were observed at the midpoint of implementation. Peak NOWS scores decreased significantly from baseline to midpoint (12.3 vs. 8.4, p <.001). Infants were more likely to be discharged to their mothers (75.9% vs. 17.2%, p <.001) and to be monitored throughout hospitalization (70.8% vs. 24.0%, p=.002) at the implementation midpoint than at baseline. Maternal prenatal visits increased significantly (5.5 vs. 9.4 visits, p=.002), as did rooming-in duration (2.7 vs. 5.5 days, p<.001) and lactation consultation completion (14.8% vs. 60.8%, p=.001). Qualitative findings identified training, protocol standardization, organizational support, and reduced stigma as key facilitators of implementation. Persistent barriers included staffing shortages, workflow inconsistencies, pharmacy-related challenges, and broader social and structural constraints. Integrated findings suggested that improvements in outcomes were associated with increased adoption of standardized, family-centered care practices despite ongoing implementation challenges.

Implementation of the MAiN 2.0 model was associated with improvements in NOWS severity, maternal engagement, and family-centered care processes across expansion hospitals. Continued investment in provider training, interdisciplinary coordination, and structural support may strengthen sustained implementation and improve outcomes for opioid-exposed mother-infant dyads.

Not applicable.