Processes Used by Mothers in Opioid Recovery to Manage the Needs of the Maternal-Infant Dyad: A Grounded Theory Study

Maternal opioid use during pregnancy and the postpartum period has significant impact on the mother and infant. Maternal well-being and early maternal-infant contact can impact the early attachment and bonding of the dyad. Additionally, the stigma surrounding opioid use in pregnancy can have detrimental effects on the dyad during pregnancy and in the postpartum period. Theory driven nursing interventions to promote mother-infant dyadic care for pairs impacted by maternal opioid use disorder (OUD) are needed. First, it was necessary to understand the current processes used by mothers with OUD to manage the unique needs of their dyad. The purpose of this study was to develop a situation specific theory of the processes used by women to meet the needs of the dyad impacted by OUD during pregnancy and the early postpartum period. Mothers in opioid recovery, defined through self-identification and use of medication assisted treatment (MAT) throughout pregnancy and postpartum, were asked to participate in individual semi-structured intensive interviews. Principles of a constructivist grounded theory approach were followed. Findings from this study identified six main processes that women in opioid recovery with MAT use to meet the needs of the maternal-infant dyad. Processes include, navigating social support, putting in the work of recovery, maintaining vigilance, performing self-cares, acquiring skills and knowledge, and advocacy. These processes were impacted by two personal modifying factors of a mother’s previous experience with motherhood and their freshness in recovery. This theory demonstrates the active engagement by mothers who use MAT for their recovery during their pregnancy, postpartum, and early motherhood period. With this increased understanding of the processes women engage in and their personal modifying factors, health care providers can guide development and implementation of support services that account for the work mothers are already doing. By increasing awareness of how actively engaged mothers who use MAT for OUD are during their recovery and pregnancy, it is possible to help reduce the stigma surrounding pregnancy in recovery and improve outcomes for the dyad