Building Trust Between Pregnant Substance-Using Women and Prenatal Care Providers in a California County

Substance-using pregnant women are over-represented among women who deliver with late, limited, and no prenatal care. Substance-using women who receive adequate prenatal care generally have better birth outcomes than substance-using women who do not receive adequate prenatal care. To engage pregnant substance-using women in prenatal care, the Contra Costa Family, Maternal, and Child Health Programs recruited pregnant and parenting substance-using women to participate in the creation of a consumer-designed community awareness campaign encouraging substance-using pregnant women to seek prenatal care. Twenty individual interviews and four focus groups were conducted. Participants suggested campaign messages such as: “Talk to us, trust us. You will not be judged.” and “You won't be reported to Child Protective Services.” These suggestions describe a response from providers that differs significantly from what women reported receiving when they attended prenatal care. We realized that before we could offer these welcoming messages, prenatal care providers would need to be able to respond in ways that our campaign promised. This presentation describes the process of creating an initial campaign that provides some information and encouragement to women about prenatal care, but does not make promises about what will happen in prenatal care. It then describes the Bridges to Prenatal Care for Pregnant Substance-Using Women Project, a project that seeks to build trust by preparing the perinatal health care system in our county to work more effectively and knowledgably with substance-using women who fear being judged and fear being reported to Child Protective Services.