Unprepared: Reflections of a Labor and Delivery Nurse

Rachel Wei

As a labor and delivery nurse, I have seen first-hand the devastating effects of untreated substance use disorders (SUD) and mental illnesses in pregnancy and postpartum-- as one of the many ways our healthcare system fails to support and care for these moms and babies.

As I began working more closely with diverse patient populations, I realized how often behavioral health issues and other social influencers go unaddressed. I once took care of a young woman struggling with cocaine addiction admitted to the hospital in preterm labor. She explained that she had stopped attending her prenatal appointments after the first trimester due to intimate partner violence and the chaos it caused in her home life.

While she was able to escape that situation, its stress had triggered her depression and driven her to resume cocaine use during her pregnancy. Her relapse made her reluctant to return to prenatal appointments due to the shame she felt and fear of legal repercussions. By the end of my shift, this patient had to be delivered emergently via C-section due to a life-threatening labor complication (likely exacerbated by her cocaine use).

While I was able to help treat some of this woman's physical needs that night, I felt helpless to address the complex array of social needs that would be vital to her recovery and could have prevented much harm in the first place. This patient showed me how unprepared I was as a nurse to provide the support and resources this patient needed. She also demonstrated how woefully ill-equipped our healthcare system is to properly support pregnant people struggling with substance use disorder, mental illness, and other social issues that impact maternal and infant outcomes. In the United States, pregnant people struggling with substance use disorders (SUDs) and mental health conditions are too often stigmatized and overlooked by the maternal care system, and suffer needless and preventable harm as a result.

Pregnant people struggling with SUDs are less likely to receive consistent prenatal care due to challenges accessing care (including lack of transportation and childcare), mental illness, fear of judgment from their providers, and fear of social and criminal punishment. The last point is the most salient among Black, Indigenous, and other birthing people of color, who are disproportionately prosecuted for perinatal substance use and are more likely to be reported to child protective services by their care providers. This fear puts these mothers at higher risk of complications due to untreated substance use and other general health and obstetric issues that go unmanaged due to the lack of prenatal care. Maternal mental health conditions also remain widely underdiagnosed and undertreated, especially among Black, Indigenous, Latinx, and other pregnant people of color.

These structural drivers undergird our maternal health crisis. Saving the Lives of Moms and Babies: Addressing Racism and Socioeconomic Influencers of Health, a series of bulletins by the National Partnership for Women & Families and the National Birth Equity Collaborative, provides common-sense policy recommendations.

All birthing people deserve safe, comprehensive, and non-judgmental care. By prioritizing behavioral health, we can provide this care for the thousands of birthing people struggling with substance use disorders and mental health conditions and finally provide them with the support and services they need.

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