Leah Holcomb, Rachel Mayo, Jennifer Barkin, Kathleen Cartmell, Lior Rennert, Lori Dickes and Kacey Eichelberger, Reproductive Healthcare Professionals’ Comfort To Treat Postpartum Patients with Substance Use Disorders, Patient Education and Counseling, (2025)
doi: https://doi.org/10.1016/j.pec.2025.109276
Highlights
- Wide-Reaching Novel Survey: The study used a national, cross-sectional, survey that included open-text responses to capture detailed insights into Reproductive healthcare professionals’ (RHPs) training needs and perceived care barriers, providing a comprehensive look at both quantitative comfort levels and qualitative perceptions of training gaps.
- Limited Comfort with Intervention and Referral: RHPs reported higher comfort with screening tasks, but lower comfort with brief interventions and referrals. They expressed the lowest comfort regarding postpartum-specific issues, including substance use risks while breastfeeding, use during the postpartum period, and infant withdrawal symptoms.
- Training Needs Highlighted: RHPs emphasized the need for accessible, affordable training specifically tailored to postpartum SUD, particularly to address complex care needs and to support confidence in using screening, briefly intervening, and referring to treatment.
- Perceived Barriers to Effective Care: Participants identified several barriers to optimal care, including stigma surrounding SUD, concerns over the criminalization of substance use in pregnancy and postpartum periods, and a shortage of referral options, which were seen as challenges impacting care quality.
Abstract
Objective
Despite the increasing prevalence of substance use disorders (SUD) in pregnant and postpartum people (PPP), little is known about reproductive healthcare professionals’ (RHPs) comfort with SUD counseling, including screening, brief intervention, and referral to treatment (SBIRT). Understanding these factors is essential to improving early identification of SUD and improved care delivery. This study employed a novel Likert-scale survey to assess RHPs’ self-reported comfort with the SBIRT approach for PPP. Qualitative data was collected via open ended questions to explore perceptions of necessary training and resources to enhance support for PPPs with SUDs.
Methods
We conducted a cross-sectional survey with a national sample of RHPs (n=117). The survey captured comfort in the SBIRT approach in postpartum patient care delivery via two vignettes and associated Likert scales measuring overall comfort. The survey was assessed for validity and reliability. Analysis of free text responses within the survey explored perceptions of necessary training and resources to improve care delivery.
Results
Participants were mostly White (77.8%) and female (93.2%), and ages ranged 22-55 years. The opioid, methamphetamine, and overall comfort scales demonstrated strong internal reliability (Cronbach’s α =.83,.81, and.90, respectively). The mean comfort score was 61.35 (SD=10.83). Profession type (p<0.001), prior SUD-specific training (p=0.002), and higher SUD patient volume (p<0.001) were significantly associated with increased comfort. Qualitative themes emphasized the need for expanded perinatal SUD education, stigma reduction, and integrated, trauma-informed care to reduce resource gaps in postpartum screening, mental health services, and peer support programs.
Conclusion
Health professionals report a need for expanded access to postpartum-specific SUD training and increased referral options to assist patients.