Opioid use disorder (OUD) is associated with substantial morbidity and mortality for women, especially during the perinatal period. Opioid overdose has become a significant cause of maternal death in the United States, with rates highest in the immediate postpartum year. While pregnancy is a time of high motivation for healthcare engagement, unique challenges exist for pregnant women with OUD seeking both substance use treatment and maternity care, including managing change after birth. How women successfully navigate these barriers, engage in treatment, and abstain from substance use during pregnancy and postpartum is poorly understood. The aim of this study is to explore the experiences of postpartum women with OUD who successfully engaged in both substance use treatment and maternity care during pregnancy, to understand factors contributing to their ability to access care and social support. We conducted semi-structured, in-depth interviews with postpartum women in sustained recovery (n = 10) engaged in a substance use treatment program in northern New England. Interviews were analyzed using grounded theory methodology. Despite multiple barriers, women identified pregnancy as a change point from which they were able to develop self-efficacy and exercise agency in seeking care. A shift in internal motivation enabled women to disclose need for OUD treatment to maternity care providers, a profoundly significant moment. Concurrently, women developed a new capacity for self-care, demonstrated through managing relationships with providers and family members, and overcoming logistical challenges which had previously seemed overwhelming. This transformation was also expressed in making decisions based on pregnancy risk, engaging with and caring for others, and providing peer support. Women developed resilience through the interaction of inner motivation and their ability to positively utilize or transform external factors. Complex interactions occurred between individual-level changes in treatment motivation due to pregnancy, emerging self-efficacy in accessing resources, and engagement with clinicians and peers. This transformative process was identified by women as a key factor in entering recovery during pregnancy and sustaining it postpartum. Clinicians and policymakers should target the provision of services which promote resilience in pregnant women with OUD.

中文翻译：

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用他们自己的话说：对阿片类药物使用障碍的产后妇女中促进弹性和恢复的因素的定性研究

阿片类药物使用障碍（OUD）与妇女的大量发病率和死亡率相关，尤其是在围产期。阿片类药物过量已成为美国孕产妇死亡的重要原因，产后立即发病率最高。虽然怀孕是从事医疗保健工作的旺盛时期，但OUD孕妇在寻求药物使用治疗和产妇保健（包括在产后应对变化）方面面临独特的挑战。妇女如何成功地克服这些障碍，进行治疗以及在怀孕和产后不使用药物的情况知之甚少。这项研究的目的是探讨在怀孕期间成功地从事药物使用治疗和产妇保健的OUD产后妇女的经历，了解影响他们获得医疗和社会支持能力的因素。我们对在新英格兰北部从事药物滥用治疗计划的持续康复（n = 10）的产后妇女进行了半结构化，深入访谈。使用扎根的理论方法对访谈进行了分析。尽管存在多种障碍，妇女仍将怀孕视为改变点，从此她们可以发展自我效能感并在寻求照护方面锻炼身体。内部动机的转变使妇女能够向产妇保健提供者披露对OUD治疗的需求，这是非常重要的时刻。同时，妇女通过管理与提供者和家庭成员的关系并克服了过去似乎难以克服的后勤挑战，展现了自我保健的新能力。这种转变还体现在根据怀孕风险做出决策，与他人互动和照顾他人以及提供同伴支持方面。妇女通过内在动机的相互作用以及她们积极利用或改变外部因素的能力而发展了韧性。由于怀孕，治疗资源获取的自我效能以及与临床医生和同伴之间的互动，个体层面的治疗动机变化之间发生了复杂的相互作用。妇女认为这一转变过程是怀孕期间恢复健康并维持产后恢复的关键因素。临床医生和政策制定者应针对提供服务以提高OUD孕妇的适应能力。并提供同行支持。妇女通过内在动机的相互作用以及她们积极利用或改变外部因素的能力而发展了韧性。由于怀孕，治疗资源获取的自我效能以及与临床医生和同伴之间的互动，个体层面的治疗动机变化之间发生了复杂的相互作用。妇女认为这一转变过程是怀孕期间恢复健康并维持产后恢复的关键因素。临床医生和政策制定者应针对提供服务以提高OUD孕妇的适应能力。并提供同行支持。妇女通过内在动机的相互作用以及她们积极利用或改变外部因素的能力而发展了韧性。由于怀孕，治疗资源获取的自我效能以及与临床医生和同伴之间的互动，个体层面的治疗动机变化之间发生了复杂的相互作用。妇女认为这一转变过程是怀孕期间恢复健康并维持产后恢复的关键因素。临床医生和政策制定者应针对提供服务以提高OUD孕妇的适应能力。由于怀孕，治疗资源获取的自我效能以及与临床医生和同伴之间的互动，个体层面的治疗动机变化之间发生了复杂的相互作用。妇女认为这一转变过程是怀孕期间恢复健康并维持产后恢复的关键因素。临床医生和政策制定者应针对提供服务以提高OUD孕妇的适应能力。由于怀孕，治疗资源获取的自我效能以及与临床医生和同伴之间的互动，个体层面的治疗动机变化之间发生了复杂的相互作用。妇女认为这一转变过程是怀孕期间恢复健康并维持产后恢复的关键因素。临床医生和政策制定者应针对提供服务以提高OUD孕妇的适应能力。