Who cares for the mothers?: A narrative inquiry exploring substance use disorders among pregnant women

Background: The nexus between pregnancy and substance use disorders is usually studied from the perspective of the fetus, quantitatively examining the risks associated with in utero substance exposure. There is little regard for the mother and her experience. With an awareness of some of the challenges pregnant women with substance use disorders face, the purpose of this research was to explore how pregnancy and substance use disorders are situated within motherhood and to identify opportunities to shift the understanding of women’s experiences among health care professionals so more supportive care can be offered. Methods: Narrative inquiry was used for this research. The researcher engaged with three pregnant women who self-identified as having a substance use disorder.  Formal and informal conversations, field notes, and a research journal were used to collect data. Narratives were co-constructed between the researcher and each woman.  Results: The results are presented as excerpts from each woman’s narrative. Narratives extended beyond pregnancy and into a period of conditional motherhood where women were forced to meet state mandated conditions or risk loss of motherhood. Sobriety was fragile and impacted by stressful events such as child apprehension and treatment programs did not meet the needs of mothers. Conclusions: Ongoing, comprehensive services that support pregnant women and are continued into the postpartum period are needed. Peer support models may be an effective means for providing pregnancy specific substance use treatment. Treatment programs must be accessible and meet the distinct needs of women. Extensive breastfeeding support should be considered for women in recovery to promote mother infant attachment.