Systemic barriers and stigma: Healthcare provider perspectives on perinatal and neonatal care in the fentanyl crisis

Abstract

Introduction

The rise in fentanyl use during pregnancy has created new challenges in caring for women with opioid use disorders (OUD) and their infants with neonatal abstinence syndrome or neonatal opioid withdrawal syndrome (NAS/NOWS). Despite complexities in treating opioid-affected dyads, little research exists on healthcare workers' perspectives regarding fentanyl's impact on perinatal and neonatal care.

Objectives

Explore dynamic challenges fentanyl has brought to the care of perinatal women with OUD and their infants experiencing NAS/NOWS from healthcare providers' perspectives.

Methods

Fifteen healthcare providers (neonatologists, OBGYNs, nurse practitioners, registered nurses, and pediatricians) from the Pacific Northwest completed an online qualitative survey with a mixture of Likert-type and open-ended questions. Reflexive thematic analysis was used to analyze open-ended responses.

Results

Three themes emerged from provider data that reflect systemic failures in addressing the complex needs of perinatal women and their families and highlight challenges in implementation of evidence-based care: 1) Systemic Barriers to Perinatal and Infant Care, 2) Impact of Increasing Polysubstance Use on Neonates and Mothers, and 3) Stigma and Judgment from Healthcare Providers toward Perinatal Women with Substance Use Disorders.

Conclusions

Themes reflected how broad and interconnected systemic issues contribute to inadequate care and support for mothers and newborns in the context of rising fentanyl and polysubstance use. Themes echoed the root of the problems lies in systemic failures—issues within the healthcare system, societal attitudes, and policy frameworks that collectively fail to meet the complex and evolving needs of families affected by the ever-changing landscape of substance use.