A Multi Method Analysis of the Treatment of Perinatal Patients With Substance Use Disorders

In Colorado, suicide and accidental overdose are the two leading causes of death among pregnant and postpartum individuals. People with substance use disorders report mistreatment in hospital settings, yet there is limited understanding of healthcare providers' perspectives on this issue. The study aimed to investigate hospital staff perspectives on the treatment of patients in/around labor.

We surveyed 26 birthing hospitals in Colorado that are part of the Colorado Perinatal Care Quality Collaborative's substance use quality improvement initiative. 193 individuals from 19 frontier, rural, and urban hospitals responded. We collected quantitative data on attitudes and behaviors toward patients and conducted an exploratory qualitative analysis to further understand these attitudes and behaviors.

Respondents reported that their colleagues, and to a lesser extent, themselves, exhibit negative attitudes and behaviors when caring for patients with substance use disorders. Common issues highlighted biases, stereotypes, and gaps in unit-level management of these patients. The qualitative analysis revealed five themes: 1. Negative discussions about patients in professional settings, 2. Judgment and mistrust from staff, 3. Rudeness or dismissiveness from nurses, 4. Concerns about child custody, and 5. Inadequate clinical care. Respondents requested specific training in perinatal substance use care.

This study characterizes the attitudes and behaviors of birthing hospital staff toward patients with substance use disorders from the healthcare provider's perspective. The findings demonstrate persistent negative attitudes and behaviors and underscore the need for enhanced education to prepare obstetric/neonatal healthcare providers to better support this vulnerable patient population.