Evaluation of a Nurse-Led Program for Rural Pregnant Women With Opioid Use Disorder to Improve Maternal-Neonatal Outcomes

J Obstet Gynecol Neonatal Nurs. 2019 Sep;48(5):495-506. doi: 10.1016/j.jogn.2019.07.002. Epub 2019 Jul 30.


Objectives: To generate effect sizes of preliminary program outcomes and identify areas for program improvement related to a nurse-led, community-based screening, referral, and advocacy program for women with perinatal opioid use disorder (OUD): the Engaging Mothers for Positive Outcomes with Early Referrals (EMPOWER) program.

Design: We extracted outcomes retrospectively from medical records for the first 19 mother-newborn dyads who participated in the program (postintervention group). We compared these outcomes with those of 19 randomly selected mother-newborn dyads in which mothers had perinatal OUD and received care before the program launch (preintervention group).

Setting/local problem: A maternity care practice and community hospital in a rural Massachusetts county with high rates of perinatal OUD.

Patients: Women with perinatal OUD and their neonates.

Intervention/measurements: As part of the EMPOWER program, women with perinatal OUD developed individualized pregnancy plans; were referred to community resources in the prenatal period; and received education about neonatal abstinence syndrome, nonpharmacologic newborn care, and breastfeeding. We compared the pre- and postintervention groups for maternal and neonatal outcomes and prenatal community referrals and generated effect sizes using Cohen's d and Cramer's phi (Φ).

Results: Rates of breastfeeding initiation (Φ = 0.289) and continuation (Φ = 0.318), mean neonatal birth weight (d = 0.675), and length of hospital stay (d = 0.541) were greater in the postintervention group with medium effect sizes. Diagnosis of neonatal abstinence syndrome and admission to the NICU were also greater in the postintervention group, with small effect sizes (Φ = 0.246 and Φ = -0.144, respectively.) Significantly more women in the postintervention group received prenatal referrals for peer/family support services. We identified areas for program improvement as prenatal education on smoking and postpartum contraceptive use.

Conclusion: Preliminary findings suggest that the EMPOWER program may contribute to improved outcomes for mothers and newborns affected by OUD; however, further data collection after instituting program improvements is needed.

Keywords: neonatal abstinence syndrome; opioid-related disorders; pregnancy; rural health; substance use disorder.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Buprenorphine / administration & dosage
  • Databases, Factual
  • Female
  • Hospitals, Community
  • Humans
  • Infant Health*
  • Massachusetts
  • Maternal Health Services / organization & administration
  • Maternal Health*
  • Methadone / administration & dosage
  • Neonatal Abstinence Syndrome / diagnosis
  • Neonatal Abstinence Syndrome / drug therapy*
  • Neonatal Abstinence Syndrome / nursing
  • Opiate Substitution Treatment / methods*
  • Opioid-Related Disorders / diagnosis
  • Opioid-Related Disorders / nursing*
  • Practice Patterns, Nurses' / organization & administration*
  • Pregnancy
  • Program Evaluation
  • Retrospective Studies
  • Rural Population
  • Treatment Outcome
  • Young Adult


  • Buprenorphine
  • Methadone