"I just want the best for him." Pregnancy in the context of substance use disorders: Perspectives of postpartum women

Background: In the United States, the incidence of substance misuse among pregnant women has been steadily increasing. While pregnant women with substance use disorder (SUD) are in critical need of support during the prenatal period, they enter prenatal care stigmatized and facing the possibility of punitive responses. Little research has been done about how women with SUDs themselves experience pregnancy and the transition to motherhood. The aim of this study was to examine women's internal experiences of pregnancy in the context of SUD.Methods: Semi-structured interviews were conducted with n = 19 postpartum women with SUD. Data were analyzed using a semantic, thematic approach.Results: Participants expressed their thoughts and experiences about their pregnancies in four main themes: (1) fear of harming the baby; (2) fear about child welfare involvement; (3) guilt informed by recovery stage; and (4) mixed feelings about pregnancy amidst complicated circumstances. The women expressed fear about their children's well-being, coupled with motivation to protect their child and the need for clear medical information. Their expressions of guilt depended on the severity of their SUD and their stage in recovery during their pregnancy. Women entered prenatal care with mixed emotions about their pregnancy, such as guilt and excitement, in the midst of complicated life circumstances.Conclusions: These findings suggest a complexity of internal experiences for pregnant women with SUDs. Participants' feelings and experiences during pregnancy can inform practitioners' approaches to prenatal care in the context of SUDs.