Why we are recommending this best practice
Strategies for implementation
- Include “what to expect in the hospital” in the prenatal checklist. The discussion should be scheduled for the third trimester.
- Present the topic of postpartum care coordination. The postpartum period represents a time of increased vulnerabilities, and women with OUD relapse and even overdose far more often in the postpartum period than during pregnancy. Relapse is a common part of addiction, and often someone with OUD will relapse several times before successfully quitting. Forty-nine percent of women with OUD treated with medication assisted treatment (MAT) in an initial pregnancy were not in treatment at the start of a subsequent pregnancy, even with specific transition plans for MAT continuation (including warm handoffs). Of those on MAT, only 37% of women had the same MAT provider for both pregnancies. Education for the family and the patient around this is very important. Patients often have “all or none” thinking, but slips and relapses commonly occur, and it doesn’t mean failure. Stressful events are triggers for relapse, including loss of insurance and access to treatment, demands of caring for a new baby, sleep deprivation, and fear of losing child custody.
- Discuss postpartum information, such as contraception and access to psychosocial support.
- Emphasize that the first obstetrical follow-up visit is between weeks one and two.
- Engage hospital L&D staff and prenatal providers.
- Recruit from both environments (clinic/provider office and hospital) to champion the collaboration.
- Discuss important workflows and policies and ensure that prenatal care providers are sharing accurate information.
- Discuss offering an opportunity to schedule a “meet and greet” that supports a warm handoff.
- Understand the hospital’s intrapartum pain management policies in order to educate the patient on pain control options and encourage transparency regarding OUD for optimal management of pain and symptoms.
- Design an educational “what to expect in the hospital” curriculum unique to your hospital.
- Substance Abuse and Mental Health Services Administration. Clinical guidance for treating pregnant and parenting women with opioid use disorder. https://store.samhsa.gov/product/Clinical- Guidance-for-Treating-Pregnant-and-Parenting-Women-With-Opioid-Use- Disorder-and-Their-Infants/SMA18-5054. Accessed December 19, 2019.