“You have to stop using before you go to the doctor:” Barriers to prenatal care for women who use drugs during pregnancy

There is widespread speculation about causes of inadequate prenatal care for women who use illegal drugs. However, there is limited empirical evidence about barriers to prenatal care for this population. This qualitative study elicited drug-using women's perspectives on and experiences with prenatal care to identify barriers. 20 semi-structured interviews and two focus groups were conducted with women who used drugs during pregnancy. Topics were: beliefs about and attitudes towards prenatal care, experiences with prenatal care, reasons women attend/avoid prenatal care, advice they would give to other women, and recommendations for improving care. Major themes relating to decisions to enter and continue attending prenatal care include: wanting a healthy baby, readiness to reduce or stop drug use, and concern about doctors reporting them to Child Protective Services (CPS). Some women went to the doctor while using because they were concerned about the health of their fetuses. However, many women believed they had to stop using drugs before they went to the doctor. Some believed stopping use would clear their heads so their “right mind” instead of their “addict mind” would allow them to take steps for their own health and the health of their baby. Many more believed that if they went to the doctor while using, doctors would find out and report them to CPS, who would then take their children away. For women who want a healthy baby and want to reduce or stop their drug use, fear of being reported to CPS is an additional barrier to care.