“No, We Can’t Help You if You’re Pregnant”: Narratives of Perinatal Substance Use and Recovery

Background: Amid rising maternal morbidity and postpartum overdose rates, substance use among pregnant and parenting individuals remains heavily stigmatized, criminalized, and undertreated. While existing research identifies individual risk factors like stigma or screening barriers, few studies center on the lived experiences of people with histories of perinatal substance use who use drugs or explore how cycles of use and recovery unfold within layered systems of harm. Methods: This secondary qualitative analysis draws on 2 parent studies of people who use drugs in Montgomery County, Ohio, a region with overdose rates far exceeding state and national averages. Interviews were transcribed and coded using an iterative categorization approach. Codes were clustered into cross-cutting themes reflecting structural and personal dimensions of perinatal substance use. Results: Among 57 participants (mean age: 41.07 years; 49.7% female; 72.2% non-Hispanic white), 9 directly discussed perinatal drug use. Substances reported included heroin, opiates, cocaine, methamphetamine, and marijuana. Perinatal experiences revealed pervasive system involvement, including child protective services, incarceration, and mandated treatment. Three themes emerged: (1) Fragmentation and Marginalization: Pregnancy was often treated as disqualifying for treatment, postpartum marked by abrupt service withdrawal, and care systems operated in silos; (2) Fear, Stigma, and the Trauma of Care: Anticipated, enacted, and internalized stigma shaped avoidance of services and mistrust of providers; and (3) Facilitators of Positive Change: Pregnancy and parenting often sparked motivation, sustained when continuity, peer support, or medication-assisted treatment were present. Conclusions: This study highlights how perinatal substance use is shaped not only by personal history but by trauma, stigma, and institutional failure. Addressing it requires trauma-informed, harm-reduction-oriented, compassionate, and integrated care systems that support recovery with dignity and continuity across the pregnancy-postpartum continuum.