Educate all providers and administrative staff about opioid use disorder (OUD) in pregnancy, strategies for caring for patients with OUD, and develop protocols that address all team members’ roles. 

Treatment of OUD is a multidisciplinary endeavor that begins with a patient’s first encounter in the health care environment.  For this reason, all staff need to have a strong foundational understanding of OUD as a chronic illness and must be provided with adequate training and tools to interact with patients in a way that does not undermine a patient’s effort to seek care.  Understanding the underlying stigma and biases that nurses and ancillary staff may unintentionally bring to the treatment of patients should be a primary focus of all inpatient, outpatient, and ambulatory care staff.  

While the OUD epidemic affects women from all socioeconomic, racial, and cultural backgrounds, many caregivers and staff members have mistaken ideas about the reality of addiction. These misconceptions often result in a patient being denied needed treatment or alienated from the medical system before she has established care with a provider.  

In all medical settings, it is important that the first contact a woman with OUD has with the health system is one that is free of stigma and alienating language, incorporates Trauma-Informed Care, and is tailored to the individual woman’s needs. This initial meeting should be one that helps move a patient forward to an empowering relationship with her provider and toward medication assisted treatment (MAT) before her intrapartum period.  If a patient is initiating care during the intrapartum period, it is equally important that the care is viewed by all staff as an opportunity to implement the best practices for mothers and newborns included in this toolkit during the postpartum period and beyond. Pregnancy provides a unique window of opportunity when a woman is highly motivated to enter treatment not only out of concern for the health of the fetus but also because during pregnancy, she can envision a different future for herself and her child.

Staff and provider training is key to disrupting the stigmatizing interactions that women with OUD encounter or perceive when they present for care. Recognizing OUD as a chronic illness is imperative to providing patient-centered care that establishes a trusting and safe environment.  The first contact for these women in both inpatient and outpatient settings, often at registration or reception, needs to be free of stigmatizing behaviors and language. The subsequent encounter with a medical assistant or nurse is profoundly influenced by the presentation of the patient from the initial contact.  Whether or not a patient has sought prenatal care, her parity, family structure, history, and other factors all influence how she is perceived and received.   Many factors can contribute to initial perceptions of patients by staff and nurses, and targeted interventions have been shown to significantly impact how women with substance use disorder (SUD) or opioid use disorder (OUD) are distinguished from other patients presenting for care.