Problematic substance use in midwives registered with the United Kingdom's Nursing and Midwifery Council: A pragmatic mixed methods study. (September 2022)

• Record Type: Journal Article
• Authors: Pezaro, Sally; Maher, Karen; Bailey, Elizabeth; Pearce, Gemma
• Is Part Of: Midwifery. Volume 112(2022)
• Publication Date: 2022-09
• Subjects: Midwives -- Midwifery -- Substance use -- Addiction -- Impairment -- Occupational health; Midwifery -- Periodicals; Midwifery -- Periodicals; Sages-femmes -- Périodiques; Midwifery; Periodicals; Electronic journals; 618.2005
• DOI: 10.1016/j.midw.2022.103409
• Languages: English
• ISSNs: 0266-6138

Abstract

Highlights: Problematic Substance Use (PSU) is associated with poorer physical and mental health in midwives. Midwives engaged in PSU require compassion and support rather than discipline and punitive approaches. Education to reduce stigma may improve help seeking in midwives engaged in PSU. The naming, blaming, and shaming of midwives engaged in PSU may pose risks in relation to confidentiality, bullying and increased impairment overall. Some of the negative influences of PSU may be negated by a congruence between policies and management approaches. Abstract: Objective: Use a pragmatic mixed methods approach to provide a rich understanding of the perceptions of Problematic Substance Use (PSU) and the influences of PSU on the mental and physical health of midwives registered with the Nursing and Midwifery Council (NMC). Design: A confidential and anonymous self-administered online survey was employed to encourage wider participation. Setting: United Kingdom Participants: Midwives (n=623) registered with the NMC Measurements: Open text responses were invited throughout the survey. Along with the collection of brief demographic data, PSU was also measured using the Tobacco, Alcohol, Prescription Medications, and Substance Use/Misuse (TAPS) Tool whilst mental and physical health was measured via version 2 of the Medical Outcomes Study Short-Form 12-Item Health Survey. All qualitative open text responses were analysed inductively using reflexive thematic analysis. Multiple regression was used to test whether health outcomes in the sample as a whole were predicted by PSU and Mann-Whitney U tests to compare the health dimensions between participants who met the criteria for PSU and those who did not. Findings: PSU significantly predicted poorer general health, physical functioning, and mental functioning. Additionally, those who met criteria for PSU experienced significantly poorer general, mental, and physical health than those who did not. The influence of PSU was captured via 3 themes and 10 subthemes. Though the signs and symptoms of PSU identified remained broadly consistent, approaches to management did not. Many midwives were conflicted in how they might seek support without facing professional, personal and practical reprisal. Key conclusions and implications for practice: PSU in midwifery populations poses professional, personal, and occupational risks. Congruence between policies and approaches to identification and management may reduce risk overall. Future interventions including educational and practitioner health programmes could also be usefully co-created with midwives, policy, and decision makers to reduce stigmatising attitudes and encourage greater awareness, compassion and help seeking to appropriate sources.