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Background: Intimate partner abuse of pregnant women has been linked to the delivery of low-birth-weight infants. Also, abused pregnant women have reported a greater prevalence of substance abuse, poor nutrition, and demographic risk factors for poor birth outcomes. These factors may play a role in the reported relation between intimate partner violence and birth weight., Objectives: To explore the role of substance abuse (smoking, alcohol, and drug use) and weight gain of less than 15 pounds during pregnancy as potential mediators of the relation between recent partner abuse and infant birth weight, and to investigate the role of demographic risk factors as potential moderators for the impact of abuse on birth weight., Methods: Data were extracted on abuse screening results, demographics, birth outcomes, and a range of medical and obstetric risks and complications from the medical records of 1969 women who had been screened by clinicians for domestic abuse during pregnancy. Hypotheses were tested using multiple regression analysis., Results: Recent physical or psychological abuse had a small but significant effect on birth weight in this sample. Smoking and low weight gain were weak but significant mediators of the relation between recent abuse and infant birth weight. Single marital status was the strongest demographic predictor of decreased birth weight. No moderator effects were found., Conclusions: Although prospective studies are warranted, nursing care to reduce smoking and promote adequate weight gain in all women along with support for women's efforts to seek safety from abuse may help to improve birth outcomes and promote maternal well-being.

This grounded formal theory study was designed to develop a midrange theory of women's addiction recovery from multiple substantive reports. Ten research reports from diverse contexts were analyzed using theoretical sampling and constant comparison. The basic problem of addiction was found to be self-destructive self-nurturing. The basic process of recovery was truthful self-nurturing, which required a painful awareness shift in which addiction gained meaning as a problem. Subsequent recovery involved three areas of social-psychological change: abstinence work, self-work, and connection work. Consequences were enjoying simple pleasures, growing self-understanding, self-acceptance, and sense of belonging, and empowered connectedness. The theory was supported by findings of other qualitative studies of the same phenomenon.

Drug treatment is a diverse field in which a variety of treatment frameworks and formats exist, few of which have been tailored to women's circumstances and needs. Most drug treatment is based on insight-oriented and behavioral approaches, often accompanied by pharmacologic treatments. Complementary approaches such as acupuncture and biofeedback also are available. Feminist criticisms of traditional therapy have prompted development of woman-centered treatment, which provides a safe environment for empowerment and building relationship skills. Nurses can provide supportive interventions using mutuality and avoiding confrontation, and can advocate for access to woman-centered drug treatment and harm reduction measures to minimize the damage caused by alcohol and drugs.

Objective: Pilot study to describe the process and stages of pregnant and postpartum women's recovery from drug addiction., Design: Naturalistic inquiry directed by the grounded theory approach of constant comparison and theoretical sampling, including individual interviews and a focus group., Setting: A hospital-affiliated, nurse-directed comprehensive drug treatment program for pregnant and postpartum women., Participants: Fourteen pregnant and postpartum women enrolled in substance abuse treatment completed individual interviews, and 3 substance abuse counselors completed a focus group., Main Outcome Measures: Grounded theory analysis of the process and stages of addiction and recovery., Results: Abstinence was short-lived unless supported by the long, intensive process of reconstructing an identity as a member of society. The basic process of recovery, "reclaiming normal life," consisted of four stages: "rescue or refuge," "no fun any more," "leaving drugs but not the life," and "building a life." An important transition point, "clearing up," was identified between the third and fourth stages. Nine dimensions of attitude changed across the stages., Conclusions: Nurses can assess women's stage of drug use or recovery, considering attitudes typical of each stage in nurse-patient interactions. Future research may enable tailoring of interventions to women's stages of addiction and recovery.

A grounded theory was developed to describe how pregnant crack cocaine users perceived their problems and responded to them. A basic social psychological process, salvaging self, was identified from constant comparative analysis of in-depth interviews with 60 pregnant or postpartum women who used crack cocaine an average of at least once per week in pregnancy. Salvaging self included two phases, facing the situation and evading harm. Participants evaluated the value, hope, and risk of various responses to pregnancy. Actions included strategies of harm reduction and stigma management aimed at reducing damage to the fetus, their identities as individuals and mothers, and the maternal-child relationship. Personal histories and social contexts influenced the salvaging process.

Mothers who use crack cocaine are commonly believed to be selfish, uncaring, and neglectful of their children. For this paper, the grounded theory method was used to analyze 68 semi-structured depth interviews with cocaine-using mothers. These women's views of motherhood, the strategies they used to manage mothering on cocaine, and the contextual influences on mothering outcomes were explored. Contrary to popular assumptions, the women highly valued motherhood and held firm standards for childrearing. Mothers were concerned about the possible risks to their children and used a process of defensive compensation to protect both their children and their maternal identities from the negative influences of crack cocaine. When unable to fulfil their maternal responsibilities by other means, some mothers placed their children with family members, and others lost custody involuntarily. When children were forcibly removed, mothers often increased their drug use to cope with the loss. Social and economic conditions influenced the outcomes of mothering on crack.