5 - (SYM 48) a Pilot Feasibility Study of Expanded Labor Support for Pregnant Patients Receiving Substance Use Disorder Treatment

Objective: Intersecting barriers to health care and wellbeing impact pregnant people who are managing substance use disorder (SUD), including lack of treatment access, lack of social support, and stigmatization. Doulas are trained non-medical paraprofessionals who could reduce these barriers by providing support to patients during the prenatal, labor and delivery, and postpartum periods. Doulas, often associated with continuous labor support, provide non-judgmental emotional, physical, informational, and partner support to perinatal patients. This fosters development of navigation skills, self-advocacy, and trusting relationships in medical settings. This was a pilot feasibility study of providing expanded doula care to patients enrolled in an integrated maternity/SUD care clinic.

Methods: The research team was a partnership between the University of New Mexico (UNM), The UNM Volunteer Birth Companion Program (BCP), and Bold Futures (BF: a community reproductive justice organization). Doulas hired from BCP received additional training in trauma and SUD-informed care. We recruited patients from an integrated maternity/SUD clinic. UNM staff collected baseline/postpartum assessments including SUD, substance use, depression, and posttraumatic stress disorder. Doulas visited with patients once prenatally and once postpartum and attended labor and births. Qualitative data was collected from participants, and doulas provided feedback at study end.

Results: 10 participants (9 with doulas, 1 control) were 23 to 34 and most identified as Hispanic/Latine (70%), had comorbid mental health diagnoses (90%), had either a stimulant or opioid use disorder, and had social and financial instability. We had 100% retention, with all participants attending all assessment or doula visits. Overall, patients were very satisfied with the doula support. Doulas found the work enjoyable and satisfying but wanted more visits. Medical providers were enthusiastic, supportive, and accommodated doulas.

Conclusions: Providing doula care to pregnant patients in SUD treatment is a low-cost intervention that stands to significantly improve birthing outcomes for some of the most vulnerable families.