Scarce perinatal social support for women with OUD: Opportunities for doula services
Reading Between the Lines
October 2025
In this month’s Reading Between the Lines, we reviewed “Scarce perinatal social support for women with OUD: Opportunities for doula services” by Gannon et al. Utilizing a mixed-methods study, authors found that perinatal support networks decreased from the prenatal to postpartum period, and that doulas and peer recovery support specialists may fulfill the needed support role throughout the perinatal period for persons with opioid use disorder. Both our Epidemiologist and EMPOWER moms shared their insights on the strengths, limitations, and implications of this study.
What was the study design?
This mixed-methods study included 34 participants to explore perceived social support throughout the perinatal period for pregnant and parenting individuals with OUD. Both survey instruments and semi-structured interviews were utilized, as well as social network mapping. Qualitative and quantitative data were collected simultaneously and analyzed using a variety of statistical and inductive qualitative analysis.
What do you think about the findings?
Epidemiologist’s View
The study utilized a mixed-methods design, using both qualitative and quantitative data collection to describe the perinatal social support networks and perception of doulas of persons with opioid use disorder. Though the study included a small sample of participants, the study design was appropriate and findings have broad applicability.
EMPOWER Moms’ View
The EMPOWER Moms overall appreciated the article’s focus on doulas and their potential to support women with OUD in the perinatal period. While they acknowledged the article as generally informative and valuable, concerns were raised about the study’s limitations—including its small sample size and lack of diversity—which made it harder for some to fully trust the conclusions. They emphasized the importance of clearly defining the roles and boundaries of peer supporters and doulas. The group also highlighted the need for clearer explanations of the study’s implications, underscoring that people “need the why” to connect with research meaningfully.
Who does this study represent?
Epidemiologist’s View
This study recruited a small sample (N=34) from a single clinic to participate in this study. While a small sample is common for qualitative research, the small number of participants in this study may make the findings less generalizable to other clinics across the US. The recruitment was done via convenience sampling, which also may have biased the sample towards those who wanted to participate rather than being truly representative of the population the study is trying to represent. However, the participants that did participate all completed the study, and therefore there were no participants who were lost to follow-up.
EMPOWER Moms’ View
While the study offers valuable insights, the group of participants was small and drawn from a single urban clinic and that can limit how much we can generalize these findings. It’s also important to note who might be missing from this conversation; Indigenous, rural, or culturally diverse families who face different barriers and supports. Expanding beyond one clinic or geographic area could strengthen future studies and ensure that more lived experiences are represented.
Was the measurement of the exposure and outcome appropriate?
Epidemiologist’s View
Social support was the primary outcome in this study and it was measured both by the Medical Outcomes Study (MOS) Social Support Survey Instrument, as well as through in-depth questions in the interview. The secondary outcome of the study, interest and perception of doula and peer support, was also measured using survey questions as well as interview questions.
One of the exposures was measured by the adverse childhood experiences (ACE) tool which has limitations, but has been validated and utilized across a wide range of studies. Furthermore, previous studies have shown that this population has a higher ACE burden, and so including this measurement was appropriate.
EMPOWER Moms’ View
The EMPOWER moms appreciated that the researchers went beyond standard tools, expanding the ACEs measure to better capture real-life experiences. They saw the mixed-methods design as a major strength; it offered a fuller, more nuanced picture than numbers or interviews alone could provide. Despite limitations like a modest sample and potential recall bias, the integrated design and careful attention to social support enhanced the study’s overall credibility and depth.
A balanced view: recognizing both strengths and limitations
Strengths:
Mixed methods gives a much more in-depth answer to a research question – much more comprehensive than purely qualitative or purely quantitative
All participants who were approached about the study consented to participate – important for nonresponse or participation bias
Appropriate measures for outcome and exposure variables
Multiple measurements of social support
Limitations:
Small number (n=34) of participants in a primarily urban area from a single opioid treatment program – may not be generalizable or representative of everyone
Could be some recall bias, but questions and study design were appropriate
How could this study affect families?
Epidemiologist’s View
The study findings highlight the potential utility of doulas, especially peer support doulas in support roles for persons with OUD. It also emphasizes that more work is needed to improve awareness around the role of a doula, especially in the postpartum period, and important differences exist between participants interested in doula support and those who were not interested. Participants who were not interested in doula support relied primarily on nurses and parenting experts for information, whereas participants who expressed interest in doula support reported seeking health information from a wide variety of sources. Additionally, this study’s findings emphasize that support is more available during pregnancy compared to after the child is born. These findings speak to the importance of providing additional support after the birth of a child and the untapped potential in the role of a doula for this population.
EMPOWER Moms’ View
This study shows how support often drops off after birth and how doulas and peers could help fill that gap. For many, the word “doula” can sound a little out of reach or like something meant for someone else, not for people juggling treatment or recovery. When doulas, especially those with lived experience, are accessible and understood, they can make a real difference. They help families navigate postpartum stress, advocate within systems like CPS, and stay connected in recovery. The takeaway is simple: postpartum peer support isn’t a luxury—it’s a lifeline.
Does it reflect lived/living experience?
EMPOWER Moms’ View
Yes. The study’s descriptions of doula roles felt on point, especially the way trust, education, and advocacy were framed. Still, there’s a disconnect in how doulas are often perceived. Many people in treatment settings have never met a doula or assume it’s something “woo-woo.” The reality is that peer doulas, people who have lived experience and training, can make this support practical, relatable, and grounded.
What should researchers do next?
Epidemiologist’s View
Future research should examine the effectiveness of doulas, especially peer support doulas, as support persons during the perinatal period, particularly in the postpartum period.
EMPOWER Moms’ View
Future studies should examine how peer doulas can be woven into care as actual team members, not side support. Doulas who’ve been through recovery themselves can build the kind of trust that changes outcomes. We must also determine how to pay for and sustain these roles through real billing and reimbursement options. Since fears around mandated reporting and CPS often shape whether parents feel safe accepting help, those issues must be part of the conversation. The bottom line is that lived experience shouldn’t be an afterthought; it should be at the center of how doula programs are built.
Final thoughts
Overall, this study is a well conducted mixed-methods study that identifies a lack of support, particularly in the postpartum period, for persons with OUD. The article does a good job illustrating the value of a doula. However, almost a third of the participants of this study had never heard the term “doula”, and this highlights a significant gap in awareness around the role of a doula and their potential support role throughout the perinatal period. Persons with OUD are uniquely positioned to benefit from additional support throughout the perinatal period, and doulas, particularly peer support doulas, may be an avenue to provide that support.
Prenatal cannabis exposure and executive function and aggressive behavior at age 5 years
Reading Between the Lines
In this month's Reading Between the Lines, we reviewed a recent article published by Keim et al., titled "Prenatal Cannabis Exposure and Executive Function and Aggressive Behavior at Age 5 Years." The authors report that children exposed to cannabis during pregnancy exhibited lower executive function and increased aggression at age five. While the topic is critical and timely, both our epidemiologist and EMPOWER moms have important insights about the strengths, limitations, and real-world implications of this study.
What was the study design?
The study used a cohort of about 250 pregnant people recruited from Ohio State University’s Wexner Medical Center to assess whether prenatal cannabis exposure is linked to children’s behavior at age five. Findings showed an association between prenatal cannabis exposure and higher aggression and lower executive function in some domains.
What do you think about the findings?
Epidemiologist’s View
The study employed an ambidirectional cohort design with sound statistical methods. However, key limitations reduce the reliability of its conclusions. There was likely misclassification of both cannabis exposure (measured only once) and the child outcomes (assessed on a single day), which weakens the ability to establish a true relationship.
EMPOWER Moms’ View
While the findings suggest potential risks, they do not establish that cannabis use during pregnancy causes these developmental issues. Contextual factors such as parenting strengths, family dynamics, and social support are important variables that were absent from this study.
Who Does This Study Represent?
Epidemiologist’s View
The sample was drawn from a large academic medical center serving a diverse regional population. However, generalizability is limited, especially for populations outside non-Hispanic Black and White communities, as other racial and ethnic groups were underrepresented.
EMPOWER Moms’ View
The participants didn’t authentically reflect people who use cannabis during pregnancy. It also lacked information on dosage, frequency, or timing of cannabis use—key details that make a difference in understanding potential effects.
Was measurement of the exposure and outcome appropriate?
Epidemiologist’s View
The study is prone to bias due to one-time measurements of both exposure and outcome. This snapshot approach overlooks the variability of cannabis use and child behavior over time. There are also concerns about relying on lab-based measures that may not reflect children's typical behavior.
EMPOWER Moms’ View
The study misses perspectives from caregivers and the broader environment of the children. Children's behavior is shaped by many factors — home life, parenting style, stress, trauma, and even how comfortable they feel in a lab setting. One mom commented, “This gives me crack baby era vibes,” referring to past flawed research that stigmatized families without considering structural and social factors. "The "Crack Baby" narrative was built on racist, unproven science that has since been debunked and discredited. What we now know is that the real harm came not from prenatal substance use alone, but from the criminalization, family separation, and systemic oppression that followed. That era fueled lasting harm that we are still working to undo today.”
A Balanced View: Recognizing Both Strengths and Limitations
While the EMPOWER moms and our epidemiologist raised serious concerns about how this study could be misinterpreted or weaponized, it is also important to recognize aspects of the study that are meaningful and worth building upon.
First, the study addresses a genuinely important question. With prenatal cannabis use on the rise, understanding potential effects on child development is a reasonable and necessary area of research. The authors should be credited for focusing on a topic that has real-world relevance.
Additionally, caregiver reports and laboratory-based assessments of child behavior were used in this study. Using more than one method, even if imperfect, shows an attempt to capture complex behavioral outcomes from different perspectives. The inclusion of a more racially and socioeconomically diverse sample than many similar studies is another positive step. While the sample lacked broader racial and ethnic representation, it did include a substantial proportion of Black and low-income participants—groups often underrepresented in child development research.
The epidemiologist also noted that the study design—a prospective cohort—is generally stronger than retrospective or cross-sectional designs when trying to understand the timing of events (in this case, cannabis use during pregnancy and later child behavior). The authors further applied rigorous statistical methods and tried to adjust for confounding factors, including exposure to other substances.
Importantly, the researchers were transparent about many of the study's limitations. They acknowledged concerns about misclassification, measurement error, and generalizability, leaving the door open for more careful and inclusive future research. Furthermore, the researchers used outdated studies to support their findings versus providing any new evidence that cannabis use during pregnancy affects children’s behavior.
Despite these strengths, both the epidemiologist and EMPOWER moms agree that the findings must be interpreted cautiously. Without including lived/living experience, exploring resilience, or fully contextualizing cannabis use during pregnancy, this type of research risks perpetuating stigma and missing opportunities to truly support families.
How Could This Study Affect Families?
Epidemiologist’s View
Using this study to influence policy or clinical guidelines could increase stigma and punitive practices toward pregnant individuals who use cannabis. Punishment rather than support may discourage people from seeking prenatal care, worsening outcomes for both parents and children.
EMPOWER Moms’ View
For many of us, this study triggers fears about surveillance, child welfare involvement, and discrimination — particularly for Black and low-income parents. One mom shared, “Articles like this lead to more testing of women... It grinds my gears.” Many agreed that research like this often reinforces stigma and fails to promote supportive or harm reduction-focused policies.
Does It Reflect Lived/Living Experience?
EMPOWER Moms’ View
The study felt disconnected from our experiences. It ignores resilience, like supportive parenting and community strength, which many families demonstrate despite hardships. A mom summed it up: “It doesn’t show us what helps kids thrive — it just looks for deficits.”
What Should Researchers Do Next?
Epidemiologist’s Recommendations
Measure cannabis use multiple times across pregnancy.
Use repeated child assessments over time.
Involve people with lived/living experience in designing future studies.
EMPOWER Moms’ Suggestions
Research what helps families thrive.
Focus on harm reduction and strengths, not just risks.
Be cautious about how research might be used to justify harmful policies.
Final Thoughts
At EMPOWER, we believe research can and should help improve health without increasing fear or stigma. Studies on substance use during pregnancy must ask the right questions, include the voices of people with lived and living experiences, and recognize the complexity of parenting in today’s world.
Empower Project Partner Authors
Arielle Estes, Grace Gerdts, Michelle Gabbard, Michelle Kavouras, Nichole Nidey