Mothering Experiences of Women With Substance Use Disorders

The current ANS featured article addresses the mothering experiences of women who use substances while pregnant, and the insights that can lead to providing compassionate nursing care for the women and their infants. The article is titled “The Mothering Experiences of Women With Substance Use Disorders” by Lisa M. Cleveland, PhD, APRN, PNP-BC, IBCLC; Rebecca J. Bonugli, PhD, RN, APRN, PMHCNS and Kelly S. McGlothen, BSN, RN, IBCLC, CIMI, and is available here for download at no cost while it is featured.

Dr. Cleveland sent this message about her work:

We are so pleased to share this paper with ANS readers. This is our 3^rd publication from our research with mothers who have substance use disorders (SUDs) and as a result, they have taught us so much. I will forever be

Lisa Cleveland

grateful to these women for opening their homes and their hearts to us and for trusting us to tell their stories. It has truly been an honor and an enormous responsibility.

My interest in mothers with SUDs first began when I was conducting my dissertation study which was focused on the mothering experiences of women whose infants had been admitted to a neonatal intensive care unit (NICU). This was a grounded theory study to gain a better understanding of the process mothers experience during their infants’ NICU stay. While I was recruiting and data collecting for this study, I began receiving numerous phone calls from interested women wanting to participate whose infants had been admitted to the NICU for Neonatal Abstinence Syndrome (NAS). NAS is a constellation of withdrawal symptoms experienced by infants who are prenatally exposed to addicting substances such as opioids. Most of the women who called were in recovery programs and receiving medication assisted treatment using methadone but infants exposed to methadone may still develop NAS. These women met the inclusion criteria for

Rebecca Bonugli

the study so they were enrolled and I interviewed them. I was not at all prepared for what I would discover. While all mothers who participated in the study perceived the NICU experience to be stressful, the mothers of infants with NAS described a uniquely different experience. Their experiences were filled with stories of social stigma, shame, guilt and overwhelmingly negative interactions with healthcare providers. Further, they had a strong desire to tell their stories and to be heard. I was so moved by the women that I pledged to continue my work with them upon completion of my dissertation.

As a result, when I’m asked how I came to be working with mothers who have SUDs and their infants, I often respond by saying, “I didn’t find them. They found me.” I had no idea at the time that they would become the focus of my program of research. When I completed my dissertation study, I conducted another qualitative study focused specifically on the experiences of mothers of infants with NAS. This article being featured in ANS is a report of our findings from that research. Further, due to all that my research team has learned from our qualitative work, we are now

Kelly McGlothen

truly beginning to understand the complexities of SUDs in women and the impact this has on the mothering experience. This knowledge has informed the study we are currently conducting entitled, “The impact of Kangaroo Mother Care (KMC, a method of skin-to-skin mother infant holding) on Stress Reactivity and Attachment in Mother-Infant Dyads Affected by NAS.” This is a mixed-methods study using a variety of measures to include: mother-infant salivary cortisol levels and within dyad synchronization, attachment and environmental stressor scores, length and cost of hospital stay and follow-up interviews to better understand the meaning of KMC for these mothers. We have recently received additional research funding and plan to expand our study to include assessment of prenatal salivary biomarkers of stress and post-discharge mother/infant follow-up including assessment of infants’ neurobehavioral organization and development over time.

Writing this manuscript with my treasured co-authors and continuing this research with the esteemed researchers who have now become my research team has truly been a dream and a passion of the heart. Thank you to the women who have so graciously shared their stories and families with us and for letting us become a part of their lives. They inspire me every day.

Cleveland LM. Newborn Abstinence Syndrome (accepted/in press). The North American Nursing Diagnosis Association-International

Cleveland LM, Bonugli RJ. Neonatal Intensive Care Unit Experiences of Mothers of Infants with Neonatal Abstinence Syndrome. Journal of Obstetrics Gynecology and Neonatal Nurses, 2014 May; 43:318-329.

Cleveland LM, Gill SL. Try not to judge: Mothers of substance exposed infants. MCN; American Journal of Maternal Child Nursing, 2013 Jul;38(4):200-205.

Cleveland LM, Horner SD. Taking Care of My Baby: Mexican-American Mothers in the Neonatal Intensive Care Unit. Issues in Comprehensive Pediatric Nursing, 2012 Jul;35(3-4):163-175.

Cleveland LM, Horner SD. Normative Cultural Values and the Experiences of Mexican-American Mothers in the Neonatal Intensive Care Unit. Advances in Neonatal Care, 2012 Apr;12(2):120-125.

Cleveland, LM. Symbolic Interactionism and Nurse-Mother Communication in the Neonatal Intensive Care Unit. Research & Theory for Nursing Practice, 2009 Jul;23(3):216-229.

Cleveland, LM. A Mexican-American Mother‘s Experience in the Neonatal Intensive Care Unit. The Journal of Perinatal & Neonatal Nursing, 2009 Jun;23(2):174-181.

Cleveland, LM. Parenting in the Neonatal Intensive Care Unit. Journal of Obstetrics, Gynecology, and Neonatal Nurses, 2008 Dec;37(6):666-691.