ReviewScoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy
Section snippets
Opioid Maintenance Therapy
Opioid maintenance therapy is the use of opioid agonists (methadone or buprenorphine) to treat OUD and was recommended for pregnant women with OUD (American College of Obstetricians and Gynecologists, 2017). The purpose of OMT is to treat withdrawal symptoms and cravings in people with opioid dependence. Pregnant women with OUD who received OMT had more consistent prenatal care, better nutrition, less risky behaviors, and better pregnancy outcomes than those who did not receive treatment (
Maternal Benefits
In their policy statement on breastfeeding, the American Academy of Pediatrics (2012) summarized the benefits of breastfeeding for all women, including reduced risk for breast cancer, ovarian cancer, Type 2 diabetes, cardiovascular disease, postpartum depression, and rheumatoid arthritis. Some evidence suggests that breastfeeding among healthy women is associated with improved mental health outcomes, including reduced anxiety (Godfrey & Lawrence, 2010; Mikšić et al., 2020). Because women with
Rates of Breastfeeding for Women on OMT
Estimates of how many women on OMT initiate and maintain breastfeeding vary considerably. In their review of nine studies with samples of 22 to 437 women, Tsai and Doan (2016) found that 8% to 81% of women on OMT initiated breastfeeding. In their chart review of 276 infants of mothers on OMT, Wachman et al. (2010) reported that 24% of the women who met institution-specific breastfeeding eligibility criteria initiated breastfeeding; of those, 60% stopped breastfeeding within 1 week. The findings
Barriers to Breastfeeding
Women with OUD are more likely than other women to have lower levels of education, lower incomes, less stable living arrangements, and fewer physical and social resources (Cleveland & Grossman, 2019). These factors likely add to their struggle to successfully adapt to developmental changes of the perinatal period, cope with newborns with NOWS, and meet the demands of their own addiction treatment.
Unlike other primates, humans are dependent on social learning to successfully initiate and sustain
Facilitators of Breastfeeding
Fewer researchers have investigated interventions to facilitate breastfeeding compared with those who have focused on barriers. Doerzbacher and Chang (2019) found a lack of evidence-based interventions currently in use to increase breastfeeding among women with OUD in their systematic review of four studies. The significant interventions all focused on alternative models of care, including integrated addiction and prenatal care, rooming in during the postpartum hospitalization, and outpatient
Methods
To facilitate a broader understanding of the needs of women on OMT who intend to breastfeed, we chose a scoping review to explore related literature. We used the principles described by Peterson et al. (2017) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews Checklist (Tricco et al., 2018) to guide our methods. These methods include clearly defining a research question in the context of current knowledge, establishing inclusion and
Characteristics of Studies
After screening titles for relevance and duplicates, we chose 14 articles for inclusion in the review, including five qualitative studies, three reviews (one systematic, one literature review, one review of evidence), three mixed-methods studies, two retrospective cohort studies, and one case report. Ten of the 14 articles are new sources of information specific to barriers and facilitators of breastfeeding for women on OMT that were not included in previous reviews.
Five of the included studies
Information
In their report on the role of law and policy to implement the Healthy People 2020 goals, Barraza et al. (2020) identified better maternity care and provider training as essential to attaining breastfeeding goals in the United States. We found that better maternity care through improved education for health care professionals is critical for breastfeeding success among women on OMT. We found that barriers and facilitators to breastfeeding among women on OMT are related to the absence or
Conclusion
Our results show that a lack of information among women, their families, and members of the health care team is the most significant barrier to successful breastfeeding in this population. Nonsupportive health care system factors that do not meet the unique needs of women on OMT and their newborns are also important barriers. Alternatively, providing accurate information and adequate support from family and friends, dedicated lactation specialists, and sensitive attitudes on the part of
Conflict of Interest
The authors report no conflicts of interest or relevant financial relationships.
Funding
None.
Margaret Doerzbacher, RN, MSN, NNP-BC, is a clinical instructor, School of Nursing, Division of Family, Community, and Health Systems Sciences, University at Buffalo, State University of New York, Buffalo, NY.
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Margaret Doerzbacher, RN, MSN, NNP-BC, is a clinical instructor, School of Nursing, Division of Family, Community, and Health Systems Sciences, University at Buffalo, State University of New York, Buffalo, NY.
Mickey Sperlich, PhD, MSW, CPM, is an assistant professor, School of Social Work, University at Buffalo, State University of New York, Buffalo, NY.
Amy Hequembourg, PhD, is the Assistant Dean for Diversity and Inclusion and an associate professor, School of Nursing, Division of Family, Community and Health Systems Sciences, University at Buffalo, State University of New York, Buffalo, NY.
Yu-Ping Chang, PhD, RN, FGSA, FAAN, FIAAN, is the Patricia H. and Richard E. Garman Endowed Professor and Senior Associate Dean, School of Nursing, University at Buffalo, State University of New York, Buffalo, NY.