Available online 31 January 2023

Section snippetsRecommendation•

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) recommends that pain be adequately managed per national standards of care for all people during the intrapartum period, including those who have opioid use disorder (OUD).

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During instances when a laboring person is on medication-assisted therapy (MAT) for OUD or has not started therapy and is misusing opioids or other substances, the options for pain control may include epidural or spinal anesthesia and short-acting opioid

Magnitude of the Problem

The opioid epidemic is a public health crisis in the United States, and rising rates of pregnancy-associated morbidity and mortality related to substance use emphasizes the need to prioritize substance use as a patient safety issue (American College of Obstetricians and Gynecologists [ACOG], n.d.; Substance Abuse and Mental Health Services Administration [SAMHSA], 2018). Health systems, hospitals, and obstetric care providers have the responsibility to provide evidence-based health care

Screening, Testing, and Reporting

Pregnancy provides a unique opportunity to facilitate recovery when a person may be more motivated to enter treatment not only out of concern for the health of the fetus but also because there is hope for the future with their child (Caraher, 2020; Crawford et al., 2022). It is important to identify people with substance use disorder and provide individualized care in a multidisciplinary and collaborative approach (ACOG, n.d.; AWHONN, 2019). Universal verbal screening utilizing a validated

Pain Management

Nonpharmacologic pain management strategies such as water immersion, aromatherapy, massage, music therapy, imagery, and breathing techniques (Merrer et al., 2020) should be offered, when available, during the intrapartum period. Women with substance use disorder often have higher instances of trauma (Andrews et al., 2019), which may heighten pain intolerance and require the use of pharmacologic pain methods. Thus, offering adequate and timely nonpharmacologic and pharmacologic pain

Role of the Nurse

Nurses are instrumental in advocating for people during labor and birth (AWHONN, 2019) and should consistently provide respectful and trauma-informed care to all pregnant people, including those with substance (AWHONN, 2019) and opioid use disorders (Crawford et al., 2022). Nurses and other health care professionals who treat pregnant people with OUD may have conflicting views and biases that may translate to deficient, ineffective, or stigmatizing health care (Crawford et al., 2022; Renbarger

Education and Safety

Nurses should have education on evidence-based resources specific to pain management for pregnant people with OUD, including how to avoid acute withdrawal and maintain daily doses of buprenorphine or methadone during labor and birth. By collaborating with interprofessional teams, nurses can ensure the following strategies to promote safety during labor and birth:

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Develop pain control protocols that recognize increased pain sensitivity.

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Maintain daily doses of methadone or buprenorphine during

Summary

During the intrapartum period, people with OUD often encounter many unique challenges and barriers to obtaining adequate pain management and support. The literature supports the need for focused, individualized, and nonstigmatizing care, especially related to the inpatient continuation of MAT and management of pain during the intrapartum period. Using trauma-informed and harm-reduction approaches can reduce stigma and improve equitable outcomes.

Acknowledgments

AWHONN members Brieanna Flowers-Joseph, MSN, APRN, CPNP, and Emily Carder, DNP, WHNP-BC, are acknowledged for their contributions to this practice brief.

AWHONN Contextual Statement: Although the words “woman,” “women,” and “mother” and related pronouns are used herein, AWHONN recognizes the existence of diverse gender identities and acknowledges that not all individuals who present for care self-identify as women or exclusively as women. When referencing the published results of previous

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© 2023 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc.