Pregnant women with substance dependency and their midwives V2
Research type
Research Study
Full title
Pregnant women with substance dependency and their midwives: An appreciative inquiry
IRAS ID
260872
Contact name
Elaine S Moore
Contact email
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
0 years, 8 months, 29 days
Research summary
Research Summary
Research to date has explored pregnant women with substance dependency and midwives' experiences and thoughts of being the recipient or the provider of maternity care (Morris, Siebold and Webber, 2012; Miles et al, 2014). However, none appear to explore what matters to them in a collaborative way. The aim of this study is to address this gap using appreciative inquiry methodology to work collaboratively with pregnant women with substance dependency and the safeguarding midwives who care for them. This collaboration may generate new knowledge by discovering what is of value and what is it within their relationships & maternity services that matters most to them.
The study will consist of two groups of participants:
1: Pregnant women with substance dependency, residing in Ayrshire aged 16 and above
2: Safeguarding midwives working in Ayrshire.
Safeguarding midwives are a designated team of community midwives with specialist knowledge of child protection processes and of caring for vulnerable pregnant women requiring extra support during pregnancy, childbirth and post-birth.The study will take place over a period of 6 months and will involve an initial individual interview with the researcher and contribution thereafter to a series of 3 discussion groups with the researcher and other participants.
In the individual interviews and discussion groups the researcher will use Visual Inquiry (VI) techniques. A set of images featuring universally recognisable objects/subjects will be displayed on a flat surface. The researcher will ask a question from the interview schedule and participants will be asked to choose images that they feel represent their feelings associated with the question asked. This responsive process encourages the examination of self in relation to experience and gives a wider understanding of learned values where the source of these are unknown.
Summary of Results
Title of Study Safeguarding Midwives’ experiences of caring for pregnant women with substance dependency in a midwifery-led continuity of care model: An Interpretative Phenomenological Analysis Researcher I, Elaine Moore, undertook the research. I am a midwife and professional doctorate student at the University of the West of Scotland. I would like to take this opportunity to thank the midwives who took time out of their busy work lives to take part in the study. Their frank openness about their experiences caring for pregnant women with substance use was appreciated; you are truly the best of our profession.
Where and When the Study took place
The study took place between July and October 2019 in one health board in Scotland, and five safeguarding midwives took part.What is the difference between midwives and safeguarding midwives?
All midwives are educated in a university, have a degree in midwifery and are registered with the Nursing and Midwifery Council. (NMC). However, safeguarding midwives are midwives who are interested in caring for pregnant women who are thought to be vulnerable. These women may have had experience of childhood abuse, substance dependency or domestic violence. Safeguarding midwives have additional skills and education to help them care for these women during pregnancy, childbirth and after their baby is born.
Why was the research needed?
The research was needed to explore how safeguarding midwives built and maintained relationships with pregnant women with substance dependency. Much research has been done on how pregnant women with substance dependency feel about maternity services and midwives. Research has also been carried out with midwives who work in hospitals to find out how they feel about pregnant women who take substances. However, little or no research has been carried out on how safeguarding midwives build and maintain relationships with pregnant women with substance dependency. I wanted to try and understand how safeguarding midwives’ experiences of caring for women affected their relationships with the women and other professionals involved.
What did the study ask?
The study asked the midwives what their thoughts and feelings were about pregnant women with substance dependency and if these feelings had changed since they became safeguarding midwives. They were also asked if working closely with the women changed how they spoke about them with other health and social work professionals. It also wanted to find out if the midwives had any personal qualities or experiences that made it easier to build meaningful relationships with pregnant women with substance dependency.
Research Questions and Aims
Research Question One
How do Safeguarding Midwives (SGM) experience the relationship with Pregnant Women with Substance Dependency (PWSD)?Aims
a. To explore the lived experience of SGM and their relationship with PWSD
b. To explore the nature of the relationship between the SGM and PWSD in greater depth.
c. To explore professional and personal qualities that SGM may have to support their interaction with PWSD.
d. To explore any other experience or knowledge, the SGM may have to facilitate a supportive relationship with PWSD.
Research Question Two
How does this lived experience affect SGM and their relationship with the wider multi-agency team?Aim
To explore how the lived experience of caring for PWSD affects SGM relationships with other midwives and the wider multi-agency team.
Findings of studyFor ease, in the next section safeguarding midwives will be referred to as midwives and pregnant women with substance dependency as women.
Research Question One
How do Safeguarding Midwives (SGM) experience the relationship with Pregnant Women with Substance Dependency (PWSD)?Aim
a. To explore the lived experience of SGM and their relationship with PWSD
• The midwives in the study felt that they didn’t really understand women’s lives before they joined the Safeguarding Midwifery Team (SGMT). They felt this was because they cared for women for a short time in hospital settings and didn’t have much time to build relationships.
• Although they still cared for women and felt they gave good care, the time they could spend with women was directed by the needs of the area they were working in.
Aim
b. To explore the nature of the relationship between the SGM and PWSD in greater depth.• The midwives in the study felt working in a Midwifery-Led Continuity of Care model (MLCC) helped them build and maintain relationships. Midwifery-led Continuity of care is where an allocated midwife is responsible for the care of women through pregnancy, childbirth and after the birth of their baby.
• Midwives’ attitudes towards women changed a lot after they joined the team. They had more time to listen to women, and hearing their stories helped midwives understand what it meant to be a pregnant woman with substance dependency. Women changed from being an ‘addict’ to being women who happened to have an illness called addiction.
• The study found midwives’ relationships with women are based on partnership, honesty, trust, care and compassion. In the interviews, they spoke of respect, concern, worry, responsibility, care, compassion, empathy, guidance, and support. They also said everyone deserves a chance, regardless of substance use, and often go above and beyond to ensure their wellbeing.
• Midwives in the study appeared to care for women in a parent-like way. They did not think they were; however, many words they used to describe their relationships with women, particularly young women, were similar to that of parents.
Aim
c) To explore professional and personal qualities that SGM may have to support their interaction with PWSD.• Midwives in the study appeared to know themselves well. They revealed the ability to ‘see’ parts of themselves or their life stories reflected in those of the women. The midwives’ ability to know themselves well helped them appreciate where women have come from, support them in their recovery and empathise if relapse occurs.
• This understanding helped the midwife develop a relationship with women through equal partnership. In this way, the midwife-woman relationship is built on a foundation of communication, dependent on mutual respect, acceptance of differences, honesty, trust and self-awareness.Aim
d) To explore any other experience or knowledge, the SGM may have to facilitate a supportive relationship with PWSD. ‘• The midwives revealed they had a lot of academic, workplace and personal learning experiences, which they then used to help build a supportive relationship with women.
• The study showed midwives often make decisions using a knowledge ‘bank’ of personal and professional learning and experiences. With each experience, the midwife builds on what has gone before, creating new understandings and knowledge, which are then stored for future use in similar situations.
• Midwives in the study showed how they used their increased knowledge of the women to act on their behalf if they felt the women were being treated unfairly. They supported women even when other professionals didn’t believe women could change.
• The study identified a possible way midwives use all the knowledge they have gained in their personal and work lives when building and maintaining their relationships with women. This was called phronesis or ‘practical wisdom.’
• Research Question Two
How does this lived experience affect SGM and their relationship with the wider multi-agency team?Aim
To explore how the lived experience of caring for PWSD affects SGM relationships with other midwives and the wider multi-agency team.
• Sometimes, midwives in the study found their relationships with other professionals involved in the care of women strained. Midwives in the study were clear their focus was on the health and wellbeing of mother and baby. Although protecting the unborn child was an important part of their role, it was not their focus during pregnancy. Their focus was working in partnership with women to support them. They saw this as the best way of ensuring the protection of the unborn child.
• Midwives were frustrated by some health professionals’ unhelpful and judgemental attitudes towards women. They felt that it was crucial other health professionals were supported to attend training or work with the team to improve women’s experiences of maternity care.Recommendations for Policy and Practice
Policy
• Midwifery continuity of care models are now integrated into the Scottish Government policy (Scottish Government, 2017). This study demonstrates safeguarding midwives’ value continuity of care, even though working with women with substance dependency can be emotionally and intellectually challenging. As midwifery-led continuity of care is an important part of developing and maintaining relational-based care, the study recommends the further expansion of this model of care continuity to include women of all risk and in all maternity care settings.
Education
• The study highlighted how midwives formed knowledge through phronesis and underlined the importance of workplace learning. Student midwives and midwives must be given the time and opportunity to think about what they have learned about caring for pregnant women with substance dependency. Therefore, the study recommends that midwifery lecturers and clinical supervisors consider this teaching student midwives and midwives.
• Midwives in the study showed how women’s stories changed how they thought of and acted towards them. The women became ‘real people’ with a life story that led them to addiction. Thought should be given to adding women’s life stories when educating students and qualified midwives about substance dependency in pregnancy.
• Midwives in the study thought they were unprepared for the reality of caring for women. They believed being given the opportunity to shadow the team would have given them a greater understanding of the role. The study would recommend that midwives and student midwives who show an interest in specialist areas of maternity care are given the opportunity to develop their knowledge and skills by shadowing the relevant teams as part of their ongoing professional development.
Community of Practice
• Thought should be given to building a multi-disciplinary community of practice around safeguarding, including all agencies and disciplines involved with caring for women. The ability for practitioners to reflect and learn from each other may assist in improving relationships and their understanding of each service’s unique philosophies and roles in the care of women with substance dependency.
Recommendations for further research
• Further research involving pregnant women with substance dependency could be undertaken to explore women’s experiences of being cared for by midwives in the safeguarding team.
• Existing research on the effectiveness of midwifery continuity of care models revolves around medical outcomes for mum and baby. Although important, these measures do not consider the impact of women’s life-worlds on their addiction, mental health, or recovery. Future research could consider other measures, such as reduction of substance use, sustained recovery from substances and whether the baby was removed at birth as indicators of its effectiveness.
• The study demonstrated a gap in the literature regarding how midwives create and maintain their professional identity post-registration. Further research could explore this in more depth.
• Further research could be undertaken to explore the differing philosophies between maternity and social services, specifically focusing on bridging the perceived differences highlighted in this study.REC name
West of Scotland REC 3
REC reference
19/WS/0053
Date of REC Opinion
12 Jun 2019
REC opinion
Further Information Favourable Opinion