For opioid-dependent moms: 'We want to help them break out of this cycle.'
Jamie Morton is a former nurse and current postdoctoral research fellow at the University of Iowa.
She spoke about a study she led while earning her PhD at the University of Missouri that found people who use opioids around the time of their pregnancy experienced stigma that can impact their health care - and the health care received by their infants.
Missouri Health Talks gathers Missourians’ stories of access to healthcare in their own words.
Jamie Morton: Stigma itself is driven by stereotypes. We have this perception of threat and harm associated with drug use. Women who are having babies, there is this perception that they have morally deviated from what people consider the normal cultural expectations are.
My colleagues and I, we looked primarily at nurses - but anyone that could have intervened and had the opportunity to provide care for these women, if they encountered stigma from them, it shut it down. Because it just created - it was like a negative spiral. And so the way that these women reacted is that they tried to withdraw from the stigmatizing experience.
"The perception is that these women are - they're being bad mothers, they're not taking care of their child, when what the mothers are perceiving they're doing is that they're protecting them."Jamie Morton
Now imagine, if you will, that these are coming from people that are providing your care. And so these women would give up the right to be active participants in the care decisions for their infant and became very submissive. And basically, they lost their voice. And they felt that if they expressed concern over the care of their infant or disagreed with something that the healthcare team was doing, that it would be taken out on their infants.
If they continue to encounter the stigmatizing behaviors - perhaps they were treated differently going to the pediatrician's office - many times the members of these healthcare teams don't even realize that we're doing it. But nonetheless, this mother is trying to protect the child from this potential dehumanizing experience from being made to feel different. And so they don't bring them into the follow-ups because they're trying to keep their child from experiencing the stigma that they themselves have experienced. And the perception is that these women are - they're being bad mothers, they're not taking care of their child, when what the mothers are perceiving they're doing is that they're protecting them.
And as a nurse, as a health care provider, myself, I was very interested in what can we do to maybe reduce the potential for stigma being enacted. Looking specifically in the healthcare arena - education. You know, whether it's training modules, perhaps incorporating knowledge about stigma and its repercussions and self awareness of the different types of stigma into the curriculums when they're going through school.
At the personal level, the experiences that these women have kind of accumulated over time, and what happens is they develop this sense of internalized guilt and shame, and so they self stigmatize. And in that regard, there are interventions that can be done with them - cognitive behavioral therapy, motivational interviewing - things that kind of help with bolstering their self-esteem and helping them understand that they're not bad people because they wound up dealing with substance use disorder.