Prenatal Care Curriculum for Women with Substance Abuse

The goal of this project was to develop a group prenatal care curriculum for women on Methadone and Suboxone therapies. This curriculum implements best practices based on the most current research to provide prenatal care for women currently receiving treatment for substance abuse. In the 2010 National Survey on Drug Use and Health, 4.4% of pregnant women report illicit substance abuse within 30 days of the survey (SAHMSA, 2011). Women with addictive disease form a high-risk cohort with specialized needs and increased risk for poor maternal and neonatal outcomes. Group prenatal care is an innovation that will deliver specialized prenatal care without using more provider time or clinic space. Problem Statement: During pregnancy women who use illicit substances require more time with their providers for medication management, therapy, counseling, education on parenting, nutritional education, and preparatory guidance for labor and delivery. These women have increased rates of premature birth, lower breast-feeding initiation rates, and increased rates of Neonatal Intensive Care admission. Group models of prenatal care have been shown to increase breast-feeding initiation rates, decrease rates of premature birth and subsequent Neonatal Intensive Care admissions. Current prenatal care curriculum has been developed for women with non-complicated pregnancies and does not meet the needs of women on Methadone and Suboxone therapies Objectives: Develop a four unit group prenatal care curriculum for women on Methadone and Suboxone therapies, present this curriculum to Obstetric providers at the University of Utah hospital, and submit this project for poster consideration at the Western Institute of Nursing conference. Literature review: A literature search was conducted using PubMed and CINAHL. Search terms used include: group prenatal care, Methadone/Suboxone, Self-efficacy theory, substance abuse, and providers' beliefs. Current literature supports that group prenatal care increases breast feeding initiation and promotes improved self-care behaviors during pregnancy, which in turn results in fewer preterm births and Neonatal ICU admissions. In the literature women from lower socioeconomic backgrounds who self scored high on stress inventory scores had the most improved self-efficacy from group prenatal care in comparison to the traditional model of care. Implementation: Curriculum consists of four units centered on Bandura's Self-efficacy model. Each unit begins with an assessment, proceeds to education and skill building activities, and ends with a social support component. The education and skills building component is specifically designed to create self-mastery experiences that Bandura's theory hypothesizes will create self-efficacy. The four units cover traditional group prenatal care topics, such as: nutrition, exercise, relaxation techniques, pregnancy problems, infant care and feeding, and parenting and childbirth preparation. Additional topics specific to women on Methadone and Suboxone maintenance therapies are included, such as Neonatal Abstinence Syndrome and pain control options during the intra-partum and postpartum period. An introductory section is included to train facilitators to identify personal barriers when working with women from this population. Facilitators' biases and beliefs can negatively impact the success of implementation of this curriculum. Summary: The development and implementation of a successful curriculum for prenatal care of women with addictive disease will increase their self-care behaviors during pregnancy and improve their overall pregnancy outcomes