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Rural Health Information Hub

Prenatal Care Initiation Model

In the prenatal care initiation model, treatment for women who may benefit from medication for opioid use disorder (MOUD) is initiated during prenatal care. This model is important because of special considerations for treatment for women with opioid use disorder (OUD), particularly those who are pregnant.

Providers should follow specific treatment guidelines for women with OUD before, during, and after pregnancy. During pregnancy, women with OUD should be treated with methadone or buprenorphine. In the postpartum period, after delivery, women should continue MOUD and can be referred to treatment in the primary care setting, such as office-based opioid treatment (OBOT).

Implementation Considerations

In the rural setting, this model may be implemented similarly to a hub and spoke model of care, where prenatal care and initiation of MOUD is provided at the hub, and ongoing MOUD is provided at the spoke in the postpartum period. The spoke may be a primary care setting offering OBOT.

Programs should take care to provide sufficient patient education to pregnant women, focusing on the benefits and risks associated with MOUD. Programs will also want to consider integrating other support services for women who are pregnant, to ensure the health of the fetus, such as alcohol or tobacco use cessation services.

Resources to Learn More

Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants
Offers a comprehensive clinical guide for healthcare providers treating pregnant women and mothers with OUD and their infants. Based on the recommendations of experts, this guide helps providers and patients identify the most appropriate action supporting an individualized treatment decision. Covers the epidemiology of illicit drug use or misuse for women and newborns, barriers to treatment, effective interventions, and current pharmaceutical treatments.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA)
Date: 1/2018