Bridging the Gap: Provider Perspective and the Need to Improve Care for Perinatal Patients with Substance Use Disorder

February 2026

In this month’s Reading Between the Lines, we reviewed “Experiences of healthcare providers caring for pregnant individuals with substance use disorder” by Nantume et al. Utilizing qualitative methods, including focus groups and interviews, authors explored the experiences of physicians and other healthcare professionals (including nurses, doulas, peer support specialists, etc.) who care for pregnant individuals with substance use disorder (SUD). Authors found four emerging themes: 1) perceptions of pregnant individuals with SUD, 2) building trust through supportive communication and empathy, 3) provider burnout amid resource scarcity and systemic barriers, and 4) knowledge gaps in clinical management and SUD-related regulations. Both our Epidemiologist and EMPOWER moms shared their insights on the strengths, limitations, and implications of this study. 

What was the study design?

This qualitative study asked medical and non-medical healthcare team members to participate in focus groups (n=37) and interviews (n=15) to explore their experiences during the intrapartum period. Transcripts from seven focus groups and fifteen in-depth interviews were analyzed via thematic coding using Template Analysis.

What do you think about the findings?

Epidemiologist’s View

The study utilized qualitative methods to examine experiences of physicians and other healthcare professionals with pregnant individuals with SUD in-depth. The study design and analysis were appropriate for the research question and the results have clear implications for future research.

EMPOWER Moms’ View 

Overall, EMPOWER Moms felt that the results were disheartening; it was overwhelming to read that despite the significant work that has been done in this area to reduce stigma and bias, there are still training needs because there is much room for improvement. Additionally, Moms felt that though these experiences were important to document, it is time to stop measuring whether stigma exists and create interventions to prevent it: We know what the complexities are now, let’s do something about it.

Who does this study represent?

Epidemiologist’s View

This study recruited from ten hospitals across Utah, 3 tertiary medical centers and 7 rural facilities. Focus group participants (n=37) were primarily white (94.6%), female (86.5%), rural (89.2%), and nurses (78.4%). Interview participants (n=15) were also majority female (60.0%), but had more physicians (53.3%), and represented more urban facilities (60.0%). While a small sample is common for qualitative research, using healthcare facilities only in Utah make the findings less generalizable to other clinics across the US. The recruitment was done via purposive 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. 

EMPOWER Moms’ View 

EMPOWER Moms wished that the study would have included other states besides Utah but were happy to see the representation of rural facilities. 

How could this study affect families?

Epidemiologist’s View

The study findings emphasize the persistent bias that exists in rural and urban providers towards pregnant individuals with SUD. It also highlighted the shortage of specialization in rural areas to treat this population, and the corresponding training needs in these areas. Physicians and other healthcare professionals endorsed the importance of building trusting relationships with patients, but there are significant barriers that make that challenging. Lastly, the findings illustrate the lack of understanding around the clinical management of these patients and the related SUD regulations. The findings could deter pregnant individuals with SUD from seeking care for fear of stigma-based interactions, lack of specialized knowledge, and resource scarcity. 

EMPOWER Moms’ View 

EMPOWER Moms are happy that people are recognizing the importance of uncovering stigma in care settings, but wish researchers would be able to dig into it a little more than just the fact that stigma exists. Moms also emphasized that physicians and other healthcare professionals who don’t know the policies of the system they’re in, could be causing harm to patients. 

Does it reflect lived/living experience?

EMPOWER Moms felt that the physicians and other healthcare professionals bias reflected their own negative experiences with healthcare during pregnancy, specifically saying that if they hadn’t been treated so poorly, they would not be so engaged in this work. Moms also said that even as a peer supporter and someone who has lived experience, it’s almost impossible not to have bias. Moms acknowledged that though these interactions are hard, most providers just don’t know or understand the right way to handle these patients. Furthermore, people with lived experiences want to be of help to physicians and other healthcare professionals, but they may be unsure of how best to utilize people with lived experience. 

What should researchers do next?

Epidemiologist’s View

Future research should employ interventions addressing the four themes highlighted in this study and evaluate the effectiveness of the interventions for reducing stigma-based care for pregnant people with SUD.

EMPOWER Moms’ View 

This study highlighted support and resource needs for rural physicians and other healthcare professionals and funding needs for more research in this area. Many EMPOWER Moms are peer supporters and actively engaged in training the trainer programs in rural areas where there are healthcare deserts. Moms emphasized the need to support peer supporters to learn how best to communicate with healthcare professionals so that patients are not in a vulnerable position to explain their experience. Future research needs to examine the best use of peer supporters to support physicians and other healthcare professionals in providing bias free care. 

What would we do:

If conducting their own study, EMPOWER Moms would focus efforts on evaluating interventions that incorporate peer supporter specialists and peer doulas throughout pregnancy and postpartum period. Additionally, it is important to note that not all rural areas have the same barriers to quality care, so future work and training need to acknowledge the unique challenges of geographic variation in rural settings. 

Final thoughts

This study is a well conducted qualitative study that identifies specific support needs for physicians and other healthcare professionals caring for pregnant women with SUD. While the findings are known among people with lived-experience, it is important to be documented in peer-reviewed literature. Overall, this study reinforced the need to have interventions as the next step of research in this area.