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Problematic substance use_ an assessment of workplace implications in midwifery
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New research unearths midwives’ problematic substance use for the first time

In recent years the pressure midwives are under is being documented across the world. Dr Sally Pezaro and Dr Karen Maher, from Coventry university, have taken this further with research investigation, and now would like your help.


Problematic substance use: an assessment of workplace implications in midwifery
S Pezaro, K Maher, E Bailey, G Pearce
Occupational Medicine, kqab127,
Published: 19 September 2021

Read the full publication here.

Whilst the COVID-19 pandemic has undoubtedly put midwives under increased pressure, concerns about the wellbeing of midwives had already been raised long before the first lockdown in the United Kingdom (UK), which occurred during March 2020. Just prior to this date, we received survey responses from 623 registered UK midwives in relation to their problematic substance use, including barriers and behaviours in relation to help-seeking and perceptions of impairment, the results of which are to be made available online via the Journal of Occupational Medicine.

As a panellist for the Nursing and Midwifery Council’s (NMC) investigating committee Dr Sally Pezaro is often presiding over cases relating to the problematic use of drugs and/or alcohol. Indeed, a previous study identified that approximately 16% of NMC cases relate to impairment due to alcohol and 10% relate to impairment through drug use. Yet our recent literature review highlighted a lack of research in this area, particularly in the field of midwifery. Given that problematic substance use (PSU) can leave midwifery staff impaired and therefore has the potential to compromise the safety and quality of care given, this is surprising. Yet as we have found, this is a complex, difficult, anxiety inducing and otherwise challenging area of research in which to venture. As such, some people have found this work uncomfortable to engage with. Nevertheless, we are grateful to undertake this founding work because, our results demonstrate a clear need for action with stigmatising attitudes and punitive actions dissuading help-seeking and thus prolonging risks to both professionals and the public.

Our early results were shared via the British Psychological Society at their Division of Health Psychology’s annual conference earlier in 2021. Early analyses identified over a quarter of our respondents screened positive for problematic substance use in response to work-related stress and anxiety, bullying, traumatic clinical incidents, and the maintenance of their overall functioning; PSU within our study related to alcohol and a range of restricted drugs. Whilst just over 10% of those affected indicated they had sought help, more than a quarter felt that they should have sought support but did not. The reasons they gave for this related to fear of repercussions, shame, stigma, practicalities, and a perceived lack of or need for support. Those midwives who responded to the survey had predominately compassionate perceptions around impairment due to problematic substance use, with the majority agreeing that midwives with PSU should be supported and offered an employee assistance programme to aid recovery; there were a minority of harmful stigmatising attitudes displayed.

Some incidents mentioned by our survey respondents could not be reported as they related to highly identifiable episodes. Yet the full article outlines how some midwives attended work under the influence of alcohol and/or drugs, and how many indicate concern about colleagues’ substance use.

When we have discussed this work with lay members of the public and those working in other areas of the research community, we have been confronted with disbelief; people express their surprise in discovering that midwives are struggling in such ways and feeling unable to seek help as midwives deliver excellence in care every day. So, we now want to help break the taboo around methods of coping with the pressures of providing perinatal care in the current context by humanising midwives and affording them the same compassion and support as seen in both allied professions and the general public when struggling with PSU. We want to reduce risk for midwives and those in their care by continuing in this challenging and valuable field of research in an under-represented group of healthcare workers, working with policy and decision makers to develop systems for prevention and support.

What next?

The COVID-19 pandemic may well have increased the risk of PSU in healthcare professionals. Yet data in relation to midwives is often grouped into other categories rather than examined in isolation. We understand that many people are fatigued by repeated requests to engage in research, and we remain eternally grateful to everyone who has taken part in this research thus far. Over one year on from the first UK lockdown, we are now seeking 100’s of midwives to engage in our follow-up research again (whether you participated the first time around or not).

Please be assured that anything you share via this research will remain completely confidential and anonymous (we could not trace you even if we wanted to!). We are only interested in understanding, so please keep your responses anonymous and confidential too.

Early findings from this follow up work will be presented at the International Practitioner Health Summit in 2022 (The Wounded Healer conference – #woundedhealer22) to be held at the Royal College of General Practitioners Headquarters. We will ensure that your voice is heard whilst maintaining your anonymity.

Once we understand more, we are keen to move this work forward by becoming solutions focussed. Changed perceptions alongside compassionate interventions and policies as alternatives to discipline may reduce risk overall. Therefore, we invite you all to follow this project as it progresses. This project would be nothing without you all engaging – Thank you.

The best is yet to come…

Dr Sally Pezaro PhD MSc BA (Hons) PgCAPHE FRCM SFHEA RM 🌏

Dr Karen Maher, PhD, CPsychol, FHEA: @karenmaher76

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