The care pathways of women who use drugs in the perinatal period. Findings of a qualitative, longitudinal study
Background
Substance use in pregnancy is a multifaceted public health problem with many confounding factors and implications for the longterm wellbeing of both mothers and children. The Stepping Stone Study aimed to understand the experiences of women who use drugs in the perinatal period, receiving multidisciplinary and integrated treatment.
Methods
The study used a prospective longitudinal design, involving up to five indepth interviews with 36 women in four research sites in England and Scotland from early pregnancy up to 18 months postnatally, tracking women's experiences of care over time. Interviews were transcribed verbatim and data were extracted from transcripts using the framework approach.
Results
The study revealed a group of women with complex histories of disadvantange, abuse and trauma. Many women had previously lost care of their children. While specialist midwifery and substance use services often supported women prenatally; delivery and inpatient care for women and their babies and the immediate postnatal period were identified as points at which there is a need for coordinated multidisciplinary care. Access to mother and baby placements and residential treatment postnatally was also highly variable in the four sites, impacting opportunities for women to retain care of their babies.
Conclusions
Despite UK wide policy and guidance for the care of women who use/in treatment for drug use in the perinatal period, the availability of services and outcomes for women varied in the four sites. Structural and institutional factors shaped women's individual experiences and there were critical points in women's care journeys that afforded opportunities as well as barriers for accessing and engaging with services. We highlight particular gaps in support postnatally for women who have lost care of their babies while those with care of their babies are often left to navigate motherhood and complex systems alone.
