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Cross-Cutting Narratives of Opioid Use Disorder Among Pregnant Women and Mothers: Implications for Humanistic Care

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Cross-Cutting Narratives of Opioid Use Disorder Among Pregnant Women and Mothers: Implications for Humanistic Care University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations Dissertations and Theses October 2019 Cross-Cutting Narratives of Opioid Use Disorder Among Pregnant Women and Mothers: Implications for Humanistic Care Alice Fiddian-Green University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_2 Part of the Maternal and Child Health Commons, Other Anthropology Commons, and the Women's Health Commons Recommended Citation Fiddian-Green, Alice, "Cross-Cutting Narratives of Opioid Use Disorder Among Pregnant Women and Mothers: Implications for Humanistic Care" (2019). Doctoral Dissertations. 1718. https://doi.org/10.7275/15232705 https://scholarworks.umass.edu/dissertations_2/1718 This Open Access Dissertation is brought to you for free and open access by the Dissertations and Theses at ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. Cross-Cutting Narratives of Opioid Use Disorder Among Pregnant Women and Mothers: Implications for Humanistic Care A Dissertation Presented by ALICE FIDDIAN-GREEN Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY September 2019 Public Health Department of Health Promotion and Policy ã Copyright by Alice Fiddian-Green 2019 All Rights Reserved Cross-Cutting Narratives of Opioid Use Disorder Among Pregnant Women and Mothers: Implications for Humanistic Care A Dissertation Presented by ALICE FIDDIAN-GREEN Approved as to style and content by: _______________________________________ Aline C. Gubrium, Chair _______________________________________ Thomas L. Leatherman, Member _______________________________________ Elizabeth A. Evans, Member ___________________________________ Paula Stamps, Graduate Program Director Department of Health Promotion and Policy DEDICATION For my son, Evrett Fiddian-Green: your insightfulness and perseverance amaze me every day. I love you more than any words can capture. And for those that remain with me always, although not on this plane: my father, Richard Fiddian-Green, who instilled in me the importance of critical thinking, a good debate, adventure, music, and having thick skin; Aisling Mulcahy, who taught me the most about living and loving; and lastly, Sean Paul Ruane, for the questions I never thought to ask. This work is in honor of each and all of you. ACKNOWLEDGEMENTS My deepest appreciation goes to my advisor, Aline Gubrium. As they say, timing is everything. Prior to entering the doctoral program, I read a news announcement about grants from the Ford Foundation and National Institute of Child Health and Development that Aline had recently received to use digital storytelling as a tool to promote reproductive justice among adolescent women and mothers. Although I was unfamiliar with digital storytelling at that time, I was immediately drawn to the concept. I contacted Aline about the possibility of getting involved, and within weeks was participating in a digital storytelling training. Therein began my passion for narrative and storytelling as a means to promote collective empathy and equity; it was transformative. For the first three years of the doctoral program I was supported by a research assistantship that trained me in all facets of visual, digital, and qualitative research methodologies. Aline: thank you for your unflagging mentorship, friendship, support, guidance, and encouragement over the years— I am eternally grateful. My sincere thanks go to my other committee members: Tom Leatherman, for the critical conversations and always valuable anthropological insights; and to Liz Evans, for sharing your wealth of knowledge about the field of substance use research. Although Jeff Peterson left academia before this project was finished, the guidance and encouragement he provided throughout my earlier training laid important groundwork for this work. An enormous thank you goes to each and every person that participated in this research. I am endlessly grateful to all the women who allowed me to listen, and who entrusted me with their important stories. My deepest thanks also go to the professional stakeholders who took the time to share their expertise, as well as some of their own v personal stories. I intend to honor all of your expertise, time, and insights by advocating for justice-based substance use care and treatment. This dissertation was generously supported by multiple entities: a dissertation fellowship from the Center for Research on Families at the University of Massachusetts Amherst, a Summer PhD Fellowship from the UMass Amherst School of Public Health and Health Sciences, a University of Massachusetts Amherst Graduate School Dissertation Grant, and a fellowship stipend from the Interdisciplinary Studies Institute at the University of Massachusetts Amherst. Collectively, these grants and fellowships provided essential financial support that allowed me to focus my time on writing and completing this project. Thanks go to my supportive and loving immediate family: my mother, Prunella, and sisters Nina and Claire, for being proud of everything I do. To my high school crew, our bi-annual adventures, and the many belly laughs throughout this process: Cameron, Candace, Julie, and Randall. To my nearby friends for the life breaks, company, and insights: Molly T., Sarah, Angie, Molly K., Helena, Brooksley, Kelly, Kay, and Anna. And to Annie and Dana, my far away friends whose support I felt through the ether. I certainly could not have completed this project in a timely fashion without the hard work and commitment of my research assistants extraordinaire. Hannah and Jess, I am so grateful for your efforts. Many thanks also go to my fellow doctoral students that gave essential constructive feedback on my nascent defense presentation: my Interdisciplinary Studies Institute co-fellows (Kelly Giles, Chris Hammerly, Safi Shams, Thakshala Tissera, Porntip Twishime, and Aaron Yates), as well as Tai Spargo. Thank you to the doctoral students from my cohort: Lizbeth and Travis, for getting through it vi together. And finally, a big thank you goes to Dan Gerber, for your cheerleading, and to Gloria Seaman, who easily does the job of three people. I am sure there is at least one person I have overlooked, but certainly not purposefully. Completing this dissertation was clearly a collective effort. vii ABSTRACT CROSS-CUTTING NARRATIVES OF OPIOID USE DISORDER AMONG PREGNANT WOMEN AND MOTHERS: IMPLICATIONS FOR HUMANISTIC CARE SEPTEMBER 2019 ALICE FIDDIAN-GREEN, B.S., UNIVERSITY OF MASSACHUSETTS AMHERST M.P.H., UNIVERSITY OF MASSACHUSETTS AMHERST Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Aline C. Gubrium Opioid-related fatalities in the U.S. have increased drastically. Pregnant women and mothers with opioid use disorders (OUD) are a rapidly growing and vulnerable population. Using a critical narrative approach, this dissertation examines how the syndemic of trauma, substance use, and mental health conditions influences opioid use and treatment trajectories among pregnant women and mothers across the lifecourse. The goal of this dissertation was to examine three discursive resources that shape the social construction of perinatal and maternal opioid use across all strata of social life: macro- level (news media), meso-level (scientific), and micro-level (individual) narratives. Informed by 18-months of ethnographic observation, in-depth interviews, and mixed methods analysis of scientific research and news media coverage of perinatal and maternal OUD, this research brings together the voices of women in recovery, clinicians, social workers, policymakers, and the public. Building from what Sanders (2014) refers to as the “gendered double standard” faced by women with substance use disorders, in this dissertation I characterize the intersecting identities of female, pregnant/mother, and substance user as a gendered triple standard. Throughout this work I argue that being held to this gendered triple standard intensifies the stigma faced by pregnant women and mothers with OUD as they navigate the medical, legal, and social service institutions. Key findings from this research include: (1) a predominating focus on “fetal victimhood” (Knight, 2015), which overlooks the needs of pregnant women and mothers with OUD that run concurrent to ensuring a healthy pregnancy and birth; (2) approaches to addressing the opioid “crisis” that elide key at-risk populations (e.g. People of Color, active substance users, and polysubstance users); (3) “folk” pharmacokinetic knowledge and practices utilized by pregnant women and mothers that function as both facilitators and barriers to treatment engagement; and (4) the traumas associated with institutional policies and procedures specific to the management of opioid use (e.g., practices associated with civil commitment to treatment, loss of custody, and intergenerational family separation via the criminal justice and/or foster care systems). Informed by key viii findings, this dissertation concludes with five specific recommendations for research and practice. ix TABLE OF CONTENTS Page ACKNOWLEDGEMENTS .................................................................................................v ABSTRACT ....................................................................................................................
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