Experiences of healthcare providers caring for pregnant individuals with substance use disorder.

Abstract

Substance use disorder (SUD) during pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes, yet many patients face significant barriers to accessing treatment, including experiencing bias and stigma from healthcare providers. To inform improvements in care delivery, this study explored the experiences of healthcare providers who care for pregnant individuals with SUD. Researchers conducted seven focus group discussions (FGD) and fifteen in-depth interviews (IDI) using semi-structured guides, with participants drawn from both rural and urban hospital settings across Utah. All discussions were audio recorded, transcribed verbatim, and examined using the Template Analysis approach. Among FGD participants (n = 37), the sample was predominantly white (94.6 %), female (86.5 %), rural (89.2 %), and comprised of nurses (78.4 %). The IDI sample (n = 15) was more gender diverse (60 % female), had greater representation of physicians (53.3 %), and a higher proportion of urban participants (60.0 %). Template analysis revealed four major themes. First, providers held a range of perceptions toward pregnant individuals with SUD, reflecting both stigma and empathy. Second, many emphasized the importance of building trust through nonjudgmental communication and emotional support. Third, providers reported high levels of burnout, particularly due to limited resources and systemic barriers. Finally, participants highlighted knowledge gaps related to SUD clinical care and confusion around regulatory requirements like mandatory reporting. Despite the challenges described, many providers expressed strong dedication to delivering compassionate, person-centered care. The findings underscore the need for targeted provider education, institutional policies that reduce care barriers, and increased community and institutional resources to better support patients with SUD during pregnancy.