Defense Date


Graduation Date

Summer 1-1-2017


Immediate Access

Submission Type


Degree Name





School of Nursing

Committee Chair

Rebecca Kronk

Committee Member

Alison Colbert

Committee Member

Karen Jakub

Committee Member

Lenora Marcellus


Neonatal abstinence syndrome; Pregnancy; Rural women; Substance use disorder; Vulnerable populations


Perinatal opioid use and neonatal withdrawal continue to rise rapidly in the face of the growing epidemic of opioid addiction in the United States, with rural areas more severely impacted. Despite several decades of research and development of practice guidelines, maternal and neonatal outcomes have not improved substantially. This focused ethnography aimed to address that gap by exploring rural women’s experiences and perceptions of care to inform development of efficacious, holistic models of care to improve outcomes for these women and their children. Participant observations, oral accounts and formal interviews, and artifact review (i.e., health records, any print and electronic resources provided to the women to support direct care, and media documentation of the sociopolitical environment influencing the women’s care) were used to seek answers to the following questions: a) What are the experiences and perceptions of women with substance use disorder regarding the care they received during their pregnancy and through their infants’ hospitalization? and b) How have their experiences supported or inhibited their ability to bond with their baby?

Thirteen participants were recruited through perinatal outpatient practices and hospital social workers. Their personal accounts, reinforced by participant observation and artifact review, uncovered three domains with underlying themes: access (service availability, distance/geographic location, transportation, provider collaboration/coordination, physical and emotional safety), care of the baby (proximity, information), and relationships (respect, empathy, familiarity, inclusion, interactions with care providers). The findings highlight the need for providers and policy makers to reduce barriers to care related to logistics, stigma, judgment, and lack of understanding of perinatal addiction.