Initiation and Engagement with Methadone Treatment among Pregnant and Postpartum Women.

Purpose: The purpose of this study was to explore perceptions of experiences and challenges with methadone maintenance treatment (MMT) and obstetrical care among pregnant and postpartum women enrolled in a methadone maintenance program.

Research Design: The study featured a grounded theory approach including two focus groups with pregnant and postpartum methadone users at a methadone maintenance clinic in Worcester, Massachusetts. Two research team members conducted and recorded focus groups, which took approximately 45 minutes to 1 hour. Grounded theory was used to guide data analysis and open coding, where transcripts were reviewed line by line to create code definitions as concepts emerged inductively from the data.

Results: Five emergent themes were derived from the data: 1) guilt, coupled with fear of negative outcomes for their infant, dictates women's MMT treatment decisions; 2) finding obstetricians with experience treating pregnant women using methadone can be a challenge; 3) methadone clinic physicians are instrumental in helping women find the right methadone dose during pregnancy; 4) some women had strong preferences for methadone over buprenorphine; and 5) women face substantial substance abuse treatment challenges after delivery.

Conclusions: Women experience substantial challenges engaging in MMT during the perinatal period. Additional challenges arise from finding obstetrical providers who have experience with MMT and are willing to care for pregnant women. This study may provide a starting point for future interventions seeking to improve care coordination between substance abuse treatment and prenatal care programs.