Mothers with a substance use disorder

Background: In Malta pregnant women with a substance use disorder have been specially cared for since 2006. At the time we realised that these women were being followed by a multitude of services, but many were falling between stools. There was no communication whatsoever between professionals and many pregnant women were showing up late in pregnancy for booking in the local hospital. After a very important seminar where all professionals concerned met and discussed the issue, a motto was chosen: Make Mummy better. It was decided that we would strive to work together to help pregnant women with a substance use disorder, connect with their child in utero and support them to achieve abstinence.

Method: The Pompidou Team asked us to participate in their project called: Children whose parents use drugs. They asked us to interview women who were using drugs while pregnant and we adapted and translated into Maltese their questionnaire. All mothers who come to our Substance Misuse Outpatients Unit were approached and asked for an interview and eight responded and participated.

Results:

1.     Long time passes waiting for services

2.     Changing of professionals

3.     Different care pathways and lack of communication amongst professionals

4.     Professionals’ interest only out of duty

5.     Professionals’ stigmatization

6.     Treating all women alike

7.     Inexperienced professionals

8.     Lack of child-minding services

Conclusions: Although we have been trying to make the services less daunting and more accessible, we do realise that a lot of fear of losing the children still exists amongst women who use substances. Sharing of information with all the professionals involved may cause fear of disclosure. The doctor-patient relationship may be jeopardised because the doctor is obliged to refer any unborn child at risk. It is not always easy to hit the right balance. Malta being such a small country also makes it difficult for women to start afresh and turn over a new leaf as their past keeps haunting them. 

A way forward would be to have better accessible services for both mother and other children especially in the first months after birth. Also involving fathers and helping them attach and take responsibility of their children would be of great support to the mother. And finally, making the most of our Mediterranean type of families, that are closely knit and close to each other may be of great help to the young mother with a substance use disorder.