For additional clinical guidance, access the ACOG Best Practice Recommendation Report [PDF - 1.1 MB]
Opioid Use Disorder in Pregnancy - ACOG Committee on AI/AN Women’s Health
Plans of Safe Care Toolkit - The Northwest Portland Area Indian Health Board (NPAIHB)
American Indian/Alaska Native (AI/AN) cultures have many legends about the important role of women in the creation story as the givers of life and in setting up the structures of family and community. In imagery and stories, women provide solid family foundations, protect the earth and natural resources, nurture families and distant relatives, and practice resilience. There are many factors that affect women's health and it is important to share ways to empower women to improve their physical, mental, social, and spiritual health.
The impact of substance use and the opioid epidemic has been felt in almost every community in the U.S. The statistics surrounding substance use disorder during pregnancy and the incidence of Neonatal Opioid Withdrawal Syndrome (NOWS) are staggering. Promoting wellness and recovery in pregnant and parenting AI/AN people, their children, and their families, is essential to the health of AI/AN communities and future generations.
Enhanced screening for substance use disorders in people of childbearing age, along with education and broad access to treatment services and harm reduction strategies can improve outcomes for both mothers and newborns, and help keep families together. Nurturing relationships and improving awareness about trauma-informed approaches to this complex problem can lead to recovery, hope, and healing.
A comprehensive approach to the care of pregnant and parenting people, infants, and children affected by opioid use disorder begins with caring for the pregnant person. Comprehensive care for maternal health includes:
- Increased organization of services to support a woman’s healthy pregnancy with consistent, culturally appropriate prenatal care
- Universal screening for maternal opioid use or opioid use disorder
- Repeated inquiry regarding medication, drugs of abuse, and alcohol exposure through the course of pregnancy
- Clinically determined testing of the mother’s urine for substances including drugs
- Early access to ultrasound
- Access to local holistic treatment and recovery resources and an individualized opioid use disorder treatment plan
- Attention to conditions that may increase risk of maternal morbidity or mortality including intimate partner violence, human trafficking, poverty, food insecurity, tobacco use, homelessness, depression, and/or trauma. Provider care plans should include supportive and appropriate interventions
- Avoidance of post-partum complications for the mother, including post-partum depression