This mixed-methods dissertation considers the experiences of women who used substances during pregnancy. Retrospective interviews with 15 women, currently accessing inpatient substance abuse treatment, identify trends in women’s experiences prior to accessing these services. Women report being concerned about the impact of their substance use on the developing baby, seeking information, reducing substance use outside of accessing treatment services, and engaging in healthy behaviors to protect the baby from harm. Trends related to trying to reduce harm to the baby during pregnancy are then further explored through quantitative analyses. Data on harm reduction behaviors prior to accessing treatment were collected from an additional 54 women. A clinical and research tool for visually tracking patterns of maternal substance use over the course of pregnancy was developed. This tool identifies the high prevalence of women who decrease their substance use during pregnancy outside of accessing treatment services. Clinical use of this tool is considered. In addition, a questionnaire, designed to identify engagement in harm reduction and health promoting behaviors, was administered. Data suggests that harm reduction and health promotion behaviors are common and tend to begin early on in pregnancy. Women report beginning to decrease their substance use, on average, beginning at the end of the first trimester. The timing of beginning to reduce substance use is not associated with the timing of entering substance abuse treatment in relation to a given pregnancy. However, maternal mental health and perceived barriers to accessing services do predict when, in relation to pregnancy, women enter treatment. As a whole, this research suggests that continued use of substances during pregnancy is not due to indifference towards the developing baby. Instead, women report being concerned about their babies and being engaged in the process of positive self-change. There are public health and clinical implications to these findings. This research suggests the opportunity to build upon the motivation that women have to decrease their substance use. In addition, this research suggests the importance of focusing policy and intervention efforts on addressing perceived barriers to accessing treatment services.

Being a mother is often described as a difficult but rewarding experience. Maternal parenting reward (PR) may serve an important function, helping to facilitate responsive maternal care and healthy infant development. However, it should not be taken for granted that the rewards of parenting will emerge naturally for women, particularly women who were abused by their own caregivers in childhood, within family systems that enabled or perpetuated the abuse. Despite an abundance of research on the neurobiological correlates of PR, surprisingly little is known about mothers’ self-reported experience of PR, both in general and in relation to early adversity. The aims of this survey-based dissertation were to develop and psychometrically evaluate a PR self-report measure, and to determine the extent to which childhood abuse predicts short-term (family betrayal) and long-term (maternal depression, posttraumatic stress, and problematic substance use) sequelae of abuse that are associated with diminished PR. In Study 1, with 203 mothers of young children, the final 14-item questionnaire assessed PR in a way that was not confounded with social desirability or maternal demographic characteristics, and was distinct from the related constructs of parenting pleasure and satisfaction. On average, mothers reported being highly rewarded by parenting, though there were individual differences in PR within and across mothers. In Study 2, with 270 mothers of young children, maternal history of childhood psychological and sexual abuse by caregivers each predicted diminished PR indirectly. Childhood psychological abuse was strongly associated with family betrayal, or actions and inactions by the family of origin that enabled or perpetuated abuse, which in turn predicted recent maternal depression and posttraumatic stress, each of which predicted diminished PR. The association between childhood sexual abuse and diminished PR was mediated by increased maternal posttraumatic stress symptoms only, not by family betrayal or alcohol use problems related to posttraumatic stress, as hypothesized. Although alcohol use problems predicted diminished PR at the bivariate level, they did not predict PR in the full model. Maternal childhood abuse by caregivers is indirectly associated with disruptions to the social rewards of attachment, with potential intergenerational consequences for the mother-infant relationship and infant development. / 10000-01-01