C36. Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy For Opioid Use Disorder: A Scoping Review

C36. Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy For Opioid Use Disorder: A Scoping Review

Learner category:

  • Intermediate Level

Learning objectives:

  • Participants will be able to understand the specific benefits of breastfeeding for women in treatment for opioid use disorder (OUD) and their newborns
  • Participants will be able to explain the factors that facilitate breastfeeding among women treated for OUD
  • Participants will be able to describe the modifiable barriers to breastfeeding among women treated for OUD

Abstract

Purpose: The purpose of this scoping review is to identify and synthesize the current science related to barriers and facilitators of breastfeeding among women in treatment for opioid use disorder. Background: The benefits of breastfeeding are particularly relevant for women on opioid maintenance therapy (OMT) for opioid use disorder (OUD). Among other specific benefits, breastfeeding decreases the severity of neonatal opioid withdrawal syndrome (NOWS) in the opioid-exposed newborn, promotes mental health for the mother, and facilitates maternal/infant bonding. However, breastfeeding rates in this group are low. A majority of women on OMT state an intention to breastfeed, but only a small percentage are successful beyond the first postpartum week. Several studies have revealed factors that can promote or prevent successful breastfeeding in these women, but a clear picture of how these factors interact to explain why they discontinue breastfeeding early is needed. Methods: Multiple databases including PubMed, APA PsycInfo, and CINAHL were searched for relevant research published within the past five years. The search was narrowed to qualitative and mixed-method descriptive studies related to barriers and facilitators of breastfeeding in women on opioid maintenance therapy. Fourteen studies were chosen for review. Results: Themes identified as barriers include lack of knowledge, inconsistent and inaccurate information, and misconceptions. Themes representing facilitators include the presence of support from both the social network and professional care providers. How these factors influence each other to lead women to discontinue breastfeeding early in the process remains unclear.

Authors

Margaret Doerzbacher
RN, PhD(c), NNP-BC University at Buffalo School of Nursing

Margaret (Meg) is a board-certified neonatal nurse practitioner with over thirty years’ experience working with high-risk childbearing families, including those coping with substance use disorder and newborns with neonatal opioid withdrawal syndrome. She currently teaches family nursing, maternal/newborn nursing, and nursing research at the University at Buffalo School of Nursing. She is currently a PhD candidate and the focus of her doctoral research is childbearing women with opioid use disorder. She has a passion for addressing disparities in perinatal health care and supporting breastfeeding.

Amy Hequembourg
PhD University at Buffalo School of Nursing

Amy L. Hequembourg, Ph.D., is an Associate Professor in the School of Nursing at the University at Buffalo, State University of New York. Dr. Hequembourg received her Ph.D. in Sociology from the University at Buffalo and completed a 3-year postdoctoral fellowship in alcohol etiology, funded by the National Institute on Alcohol Abuse and Alcoholism, at the University at Buffalo’s Research Institute on Addictions. Her research focuses on health disparities among sexual and gender minorities with an emphasis on interpersonal violence (e.g., lifetime sexual victimization, intimate partner violence) and sources of minority stress (e.g., microaggressions) among these populations. She has extensive experience using quantitative and qualitative research approaches. Her work has been funded by the National Institute of Justice and the National Institute on Alcohol Abuse and Alcoholism.

Mickey Sperlich
PhD, MSW, MA, CPM University at Buffalo School of Social Work

Mickey Sperlich is an assistant professor and experienced midwife and researcher who studies the effects of trauma and mental health challenges on women’s childbearing, postpartum experiences and early parenting outcomes. Her book Survivor Moms: Women’s Stories of Birthing, Mothering and Healing after Sexual Abuse, was awarded “Book of the Year” by the America College of Nurse Midwives in 2008. Sperlich is co-creator of a psychosocial intervention for pregnant survivors of abuse; the Survivor Moms’ Companion, and is dedicated to developing and evaluating trauma-specific approaches to promote healthy parenting and interrupt cycles of violence and psychiatric vulnerability. Sperlich teaches and presents about trauma and human rights, working with survivors of abuse, and the infant mental perspective, which considers ways we can promote secure primary attachments and foster well-being in relationships right from the start.

Yu-Ping Chang
PhD, RN, FGSA, FIAAN, FAAN University at Buffalo School of Nursing

Dr. Yu-Ping Chang is the Patricia H. and Richard E. Garman Endowed Professor, Associate Dean for Research and Scholarship, Department Chair – Family, Community & Health Systems Sciences and an Associate Professor in the School of Nursing with the University at Buffalo. Dr. Chang has a Masters Degree in Psychiatric/Mental Health Nursing and a PhD in Nursing. Her research focuses on integrating behavioral interventions, including motivational interviewing and mindfulness-based stress reduction, for substance abuse and mental health in primary care settings and evaluating the effects of intervention on various outcomes.

Comments (5)

  1. Melissa Belbahri

    If Baby Friendly initiatives aren’t adequate are there any more relevant tools you can recommend?
    Framing BF as helpful to recovery is a very helpful recommendation.
    Thank you

    1. Meg Doerzbacher

      Hi Melissa,
      It seems to me that part of the problem is not what happens at the time of delivery (i.e.,Baby Friendly initiatives); it’s more likely that we are not preparing women for breastfeeding before the baby is born. Breastfeeding is a learned social behavior in humans, so if women don’t start learning about breastfeeding during pregnancy, they will be overwhelmed when the baby arrives. It’s my hope that nurses working with women in treatment will begin the conversation about breastfeeding prenatally, starting with correcting common misconceptions about breastfeeding safety, etc., and helping them understand the depths of the benefits for her and her baby.
      Thank you very much for your interest, Melissa!

  2. Rachel Shuster, BSN, RN, CARN, CAAP

    Thank you so much for this presentation. Breastfeeding in this population is so misunderstood in the general medical community and by individuals within this population. I enjoyed learning that less than 1% of maternal opioid dose is present in breastmilk! Thanks for including that tidbit! I also didn’t know that many women who initiate breastfeeding discontinue doing so in about 1 week, the same amount of time it takes to establish lactation. Wow!

  3. Oluremi Adejumo

    This is an excellent presentation. Without any doubt, nurses are in a position to impart this health improvement among nursing women with opioid use disorders.

  4. Virginia Coletti

    Vdery nice presenttion andvery informative

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