Understanding Factors Contributing to the Birthing Experiences of People With Substance Use Disorder: A Qualitative Study With Healthcare Clinicians

INTRODUCTION: Despite evidence supporting comprehensive treatment for perinatal substance use disorder (SUD), access and engagement in these programs remain limited due to structural barriers, stigma, and bias. Pregnant people with SUD thus often enter birth hospitalization after negative-or absent-healthcare experiences. Although prior research has described patients' perspectives on interactions with healthcare clinicians during hospitalization and clinicians' perspectives on SUD treatment barriers, less is known about clinicians' experiences caring for this population during labor and birth in the inpatient setting. METHODS: We conducted semi-structured interviews with healthcare clinicians caring for pregnant patients with SUD during labor and delivery at a tertiary care center in New England. Interviews were transcribed, de-identified, coded using ATLAS.ti, and analyzed thematically. RESULTS: Thirteen clinicians participated. Four themes emerged: caring for pregnant patients with SUD was perceived as uniquely challenging because of increased resource needs and behavioral concerns; clinicians expressed concern about patients' ability to parent safely; clinicians described apprehension and wariness around the emotional experience of providing care; and conversely, some found caring for this population uniquely rewarding and inspiring. CONCLUSIONS: Caring for pregnant people with SUD is an emotionally charged experience that may trigger clinician bias. By viewing these patients as fundamentally different from others, clinicians contribute to the experience of stigma, mistrust of healthcare systems, and avoidance of care among patients. Efforts to reduce clinician bias and promote respectful, equitable maternity care are critical to improving patient experiences and outcomes.