Pregnant and Postpartum People with Substance Use Disorders: Understanding the Obstetrical Care Provider’ s Roles and Responsibilities

Madora, Marlee; Wetzler, Scott; Jose, Anita; Bernstein, Peter S.

doi:10.1007/s10995-022-03446-x

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Published: 21 May 2022

Pregnant and Postpartum People with Substance Use Disorders: Understanding the Obstetrical Care Provider’ s Roles and Responsibilities

Marlee Madora MD ORCID: orcid.org/0000-0003-0231-0734¹,
Scott Wetzler PhD¹,
Anita Jose PhD¹ &
Peter S. Bernstein MD, MPH²

Maternal and Child Health Journal volume 26, pages 1409–1414 (2022)Cite this article

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Abstract

Peripartum individuals with substance misuse are a high-risk population that challenge clinicians and child welfare specialists alike. Federal legislation was updated in 2016 with the Comprehensive Addiction Recovery Act (CARA) to improve care via expanded screening and treatment referrals for peripartum women with substance misuse. The implementation of CARA requires providers to update their policies and procedures in order to meet the requirements outlined by this legislation. As this is a new process, this paper reviews the new administrative reporting and safety planning requirements relevant to obstetrical care providers and provides examples of best practice for different clinical scenarios. Given the variable state laws, confidentiality concerns, influence of stigma and health inequities on substance use treatment, and the fragmented healthcare system, implementation of CARA will challenge obstetric, pediatric, and mental health care providers along with child welfare services. All entities involved must work together to create effective and efficient protocols to address the CARA requirements. Health systems must also evaluate and update methods and interventions to assure that policies improve family stability and well-being.

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Notes

This project was approved by the Albert Einstein College of Medicine Institutional Review Board. The manuscript is not based upon patient data. The authors confirm that this research was conducted in accord with prevailing ethical principles.

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Acknowledgements & Funding Information

Funding for this project was provided by the Administration for Children Youth and Families – Children’s Bureau under the Regional Partnership Grant to Improve Child Welfare Outcomes Among Substance Abusers 90CU0102-01.

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Authors and Affiliations

Department of Psychiatry and Behavioral Sciences , Montefiore Medical Center and Albert Einstein College of Medicine, 111 E. 210th St, 10467, Bronx, NY, United States
Marlee Madora MD, Scott Wetzler PhD & Anita Jose PhD
Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E. 210th St, 10467, Bronx, NY, United States
Peter S. Bernstein MD, MPH

Authors

Marlee Madora MD
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Scott Wetzler PhD
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Anita Jose PhD
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Peter S. Bernstein MD, MPH
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Correspondence to Marlee Madora MD.

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Given that no human subjects data was used, this manuscript did not require formal Institutional Review Board review. However, the authors confirm that this research was conducted in accord with prevailing ethical principles. This is also indicated in the manuscript under Footnote 1.

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Significance

This article describes the obstetrical care provider’s role in reporting and managing substance use in line with recent policy changes to promote family stability and wellbeing.

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Madora, M., Wetzler, S., Jose, A. et al. Pregnant and Postpartum People with Substance Use Disorders: Understanding the Obstetrical Care Provider’ s Roles and Responsibilities. Matern Child Health J 26, 1409–1414 (2022). https://doi.org/10.1007/s10995-022-03446-x

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Received: 11 March 2021
Revised: 25 April 2022
Accepted: 26 April 2022
Published: 21 May 2022
Issue Date: July 2022
DOI: https://doi.org/10.1007/s10995-022-03446-x

Keywords

Maternal substance use
Obstetrics
Child welfare
Comprehensive Addiction Recovery Act
Plan of Safe Care