Why we are recommending this best practice
Strategies for implementation
- Create Awareness of OUD in Pregnancy: Determine appropriate avenues through which to educate office/clinic and hospital staff about OUD in pregnancy (e.g., emails, physical bulletin boards, staff meetings) with a focus on mitigation of discrimination and bias toward patients with OUD. Utilize content such as our “Education on OUD Tool” (Refer to the Resources section of this Best Practice).
- Train Staff and Providers on Trauma-Informed Care: Create opportunities for staff and providers to learn about Trauma-Informed Care.
- Be Aware of Local Cultures: Identify “cultural coaches” to help explain the nuances of local culture that may impact care and treatment.
- Train Providers on Use of OUD Treatment Protocols: Create opportunities for providers responsible for evaluating and treating pregnant patients to learn and ask questions about facility-specific OUD treatment protocols and to obtain a waiver to prescribe buprenorphine.
- Train Nursing on Use of OUD Treatment Protocols: Create opportunities for nurses responsible for caring for pregnant inpatients to learn and ask questions about the facility-specific protocol developed as well as how to use the Clinical Opiate Withdrawal Scale (COWS) and the Ramsay Sedation Scale (Ramsay Sedation Scale) in the care of patients with OUD and how to administer buprenorphine and methadone.
- Every pregnant woman should be verbally screened for substance use at multiple points in care
- OUD is a chronic medical condition that can be treated
- Substance use is almost always connected to significant past trauma and/or Adverse Childhood Events (ACEs). A Trauma-Informed Care approach that emphasizes empathy and reduces stigma and bias is the standard of care and improves outcomes.
- MAT (methadone or buprenorphine) is the standard of care for pregnant women with OUD. Withdrawal is dangerous for both mother and fetus. MAT is linked to better maternal and neonatal outcomes and reduces overdose deaths.
- Education about the signs, symptoms, and treatment of NAS is critical. Non-pharmacologic treatment of NAS such as rooming-in, skin-to-skin contact, swaddling, and reducing external stimuli results in better support of the mother/baby dyad, reduced need for pharmacologic treatment, and shorter hospital stays.
- Treatment requires provider, peer, family, and community support. Systems of care for women with OUD should always address transitions from one location of care to another, including comprehensive discharge planning and the development of a Plan of Safe Care that ensures maternal continuation of treatment and recovery, and appropriate medical, developmental, and safety follow-up for the newborn.
- The overarching goal is to preserve the mother/baby dyad.
- Confronting the Stigma of Opioid Use Disorder and Its Treatment.
- AMA Opioid Task Force Resources.
- Words Matter: How Language Choice Can Reduce Stigma.
- SAMHSA. Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants. HHS Publication No. (SMA) 18-5054, Rockville, MD, 2018. Factsheet #2 Initiating Pharmacotherapy for Opioid Use Disorder. Factsheet #4 Managing Pharmacotherapy Over the Course of Pregnancy.
- Clinical Opiate Withdrawal Scale (COWS).
- Ramsay Sedation Scale.
- Education on OUD Tool.
- Facing addiction in America: the surgeon general's report on alcohol, drugs, and health. Chap 6: health care systems and substance use disorders. Accessed December 15, 2019. https://www.ncbi.nlm.nih.gov/books/NBK424848/.
- Opioid use disorder and pregnancy FAQ. American College of Obstetricians & Gynecologists https://www.acog.org/- /media/For-Patients/faq506.pdf?dmc=1&ts=20190509T0049178971.
- Committee opinion on opioid use and opioid use disorder in pregnancy. https://www.acog.org/Clinical-Guidance-and- Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Opioid- Use-and-Opioid-Use-Disorder-in-Pregnancy?IsMobileSet=false. Accessed December 15, 2019.