"Someone is there with you through this [pregnancy] that isn't seeing you through a negative lens": Considerations for integrating doula referrals into opioid treatment programs

Introduction: Pregnancy-associated mortality involving opioids represents a significant public health issue. Limited social support is a known factor, contributing to a more complex recovery and a greater risk for relapse and overdose. Community-based doulas have been used in other marginalized populations yet are under-studied among pregnant and parenting persons with Opioid Use Disorder (OUD). Therefore, we aimed to investigate the perspectives of Opioid Treatment Program (OTP) clinical staff and community doulas about doula support for persons with perinatal OUD to 1) describe the perceived utility of doula support and 2) identify structural considerations for integrating doula support at an OTP.

Methods: This study conducted focus groups and utilized domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Purposive sampling recruited 10 participants (5 doulas, 5 OTP staff: 1 clinical director, two counselors, one nurse, and one Community Health Worker) from an OTP program and a Philadelphia Department of Public Health Community Doula Support Program (CDSP). One focus group was held for doula staff, and two focus groups were held for OTP clinical staff. Thematic analytic procedures were used to analyze data using NVivo and an interdisciplinary coding team.

Results: Five key themes were identified from the focus group data: 1) Role of advocacy in the court system, 2) Need for collaborative care, 3) Use of doulas to de-stigmatize healthcare experiences, 4) Impact of doula support on recovery, 5) Considerations to integrating doula referrals into OTPs.

Conclusion: Perinatal doula support among persons with OUD is perceived as beneficial by critical stakeholders to advocate in healthcare and legal systems, de-stigmatize healthcare experiences, and promote recovery engagement. The implementation recommendations outlined may guide other OTPs looking to integrate doula support to improve maternal outcomes associated with opioid use.