The incidence of pregnant and postpartum women with opioid use disorders (PPWOUD) has increased infant placements in foster care. This study used Photovoice methodology to facilitate a better understanding of perceptions of motherhood in the context of substance use and child welfare involvement. Photovoice uses visual images to furnish evidence and to promote a participatory means of sharing expertise and knowledge (Wang & Burris, 1997). Results reinforce the necessity to affirm PPWOUD identities as mothers and respond empathically when providing instrumental, emotional, and relational support. In addition, mothers in the study stress the importance of dyadic support and advocacy. Motherhood changes us forever, physically, mentally, and emotionally. But a child needs to be with their mother. Moms are human and we fall short sometimes, like everyone else. And it's crucial that when mothers fall, that there are many caring hands to help them up. These babies at least deserve that. -Photovoice participant
Women of childbearing age suffer more severe adverse medical, psychological, and functional consequences of substance use disorder (SUD) than men (McHugh et al., 2017). From 1999 through 2016, mortality rates for opioid overdose increased 507% in women, compared to 321% in men (Haight et al, 2018; National Institute on Drug Abuse, 2020). The incidence of pregnant and postpartum women with opioid use disorder (PPWOUD) quadrupled between 1999 and 2013 (Maeda et al., 2014), with an increase of 127% overall, and 162% increase in 20-to-34-year-olds within that 14-year period (Maeda et al., 2014). Although PPWOUD rates of fatal and nonfatal overdoses have changed over time, there was a significant increase in overdoses seven to 12 months postpartum (Schiff et al., 2018). One of the consequences PPWOUD may experience is the separation of mothers from their infants through child welfare and criminal justice systems.
Breaking the mother-infant bond increases the need for maternal mental health services. It also increases the risk of attachment disorders in the infant, which can in turn lead to significant emotional, social, and academic issues later in the child's life and possibly to substance use disorders (Mirick & Steenrod, 2016; Netherland et al., 2009). The rising incidence of parents with opioid use disorders has resulted in more placements of infants and children in foster care; consequently, government resources allocated to serve families have been depleted (U.S. Department of Health and Human Services, 2019). Addressing maternal substance use, with particular regard to the health of mothers and infants, is a critical public health concern.
PPWOUD are at risk for myriad health challenges, including anemia, poor nutrition, depression, hypertension, hyperglycemia, sexually transmitted diseases, hepatitis, preeclampsia, and other challenges specific to pregnancy and delivery (American College of Obstetricians and Gynecologists [ACOG], 2017; Hernandez & Thompson, 2020). Clinicians often find these complications difficult to identify because PPWOUD hide symptoms due to shame, stigma, and fear of action by authorities or simply avoid prenatal care, which puts them at increased risk of mortality (Hernandez & Thompson, 2020; Guttmacher Institute, 2019). Furthermore, it has been shown that substance use can be considered...