Midwives’ experiences of caring for substance misusing women during the perinatal period

Abstract

A global increase in women engaging in substance misuse during the childbearing period has been recorded. This poses greater challenges to midwives when providing perinatal care. The aim of this study was to explore midwives’ experiences of caring for substance misusing women (SMW) during the perinatal period. The objectives were to explore midwives’ perspectives of women who misuse substances, to explore the barriers and facilitators affecting the care provided by midwives to SMW, and to explore midwives’ approaches to supporting SMW during the perinatal period. This study adopted a qualitative approach. A purposive sample of eight midwives (100% response rate) working at Obstetrics Ward 2, Obstetrics Ward 3, Central Delivery Suite, and Discharge Liaison Midwives of the general state hospital were selected and participated in a one-time, self-designated, semi-structured interview. The data collected were transcribed verbatim and analysed by thematic analysis. The findings of this study demonstrated that whilst some midwives expressed a sense of pity towards SMW, other participants were judgmental. Moreover, other midwives strived to avoid personal bias and adopt a non-judgmental attitude during the provision of perinatal care. Midwives identified that the determinants leading to substance misuse vary and are highly dependent on the nurturing environments and other social vulnerabilities encountered by these women. Participants described the several challenges they face during the provision of maternity care, which relate both to client characteristics that include women’s behaviour, midwives’ personal influences, in particular, the fear they experience when providing care to SMW, and institutional barriers, namely the lack of continuity of care. Most participants agreed that the establishment of a woman-midwife relationship, a multidisciplinary team approach, and women’s compliance are aspects that facilitate the provision of support to SMW during the perinatal period. In conclusion, midwives highlighted the importance of developing a trusting relationship with SMW through the practice of continuity of care. This study further recommends the implementation of easily accessible maternity services to SMW, the provision of further educational programmes for midwives and the exploration of the first-hand perinatal care experience of SMW for further research.