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Renbarger KM, Trainor KE, Place JM, Broadstreet A. Provider Characteristics Associated with Trust When Caring for Women Experiencing Substance Use Disorders in the Perinatal Period. J Midwifery Womens Health 2022; 67:75-94. [DOI: 10.1111/jmwh.13320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Jean Marie Place
- Department of Science and Nutrition Ball State University Muncie Indiana
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Santos GC, Baptista TWDF, Constantino P. "Whose baby is this?": challenges for homeless women's right to motherhood. CAD SAUDE PUBLICA 2021; 37:e00269320. [PMID: 34076100 DOI: 10.1590/0102-311x00269320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/06/2021] [Indexed: 11/21/2022] Open
Abstract
The experiences of homeless pregnant women create tensions in the public debate between individual guarantees and limits on State interventions. This article analyzes the scientific research on this issue, focusing on the biomedical, legal, and social arguments backing the positions in this debate. Based on an integrative review of Brazilian and international databases, the authors analyzed 21 studies and identified four propositions: Health risks for the woman and the fetus/child; Discourses on prenatal care; Rights of women and fetuses/children; and Meanings of motherhood. The article concludes that the experience of motherhood for these women is extremely complex, not only because of their homelessness, but due to the entire context, marked by unequal class, race, and gender relations. The Brazilian and international scenario features a discourse of protection and care for the fetus/infant that overrides care for the mother. The criminalization of homeless women's motherhood has been a global trend in which the expansion of "fetal/infant" rights translates as a cutback in the women's rights. Such an approach fails to encourage homeless women to seek social and health services, rather discouraging them from doing so. An ethical and humanitarian imperative is to conceive different approaches to care, grounded in a human rights perspective so that care for the fetus/child does not translate as violence against the mother.
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Affiliation(s)
- Gilney Costa Santos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Patrícia Constantino
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Escañuela Sánchez T, Matvienko-Sikar K, Linehan L, O'Donoghue K, Byrne M, Meaney S. Facilitators and barriers to substance-free pregnancies in high-income countries: A meta-synthesis of qualitative research. Women Birth 2021; 35:e99-e110. [PMID: 33935004 DOI: 10.1016/j.wombi.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/12/2021] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous studies have associated substance use (alcohol, illicit drugs and smoking) to negative pregnancy outcomes, including higher risk of stillbirth. AIM This study aims to identify facilitators and barriers reported by women to remain substance free during pregnancy. METHODS A systematic search was conducted in six databases from inception to March 2019 and updated in November 2020. Qualitative studies involving pregnant or post-partum women, from high-income countries, examining women's experiences of substance use during pregnancy were eligible. Meta-ethnography was used to facilitate this meta-synthesis. FINDINGS Twenty-two studies were included for analysis. Internal barriers included the perceived emotional and social benefits of using substances such as stress coping, and the associated feelings of shame and guilt. Finding insensitive professionals, the lack of information and discussion about risks, and lack of social support were identified as external barriers. Furthermore, the social stigma and fear of prosecution associated with substance use led some women to conceal their use. Facilitators included awareness of the health risks of substance use, having intrinsic incentives and finding support in family, friends and professionals. DISCUSSION Perceived benefits, knowledge, experiences in health care settings, and social factors all play important roles in women's behaviours. These factors can co-occur and must be considered together to be able to understand the complexity of prenatal substance use. CONCLUSION Increased clinical and community awareness of the modifiable risk factors associated with substance use during pregnancy presented in this study, is necessary to inform future prevention efforts.
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Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland.
| | | | - Laura Linehan
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland.
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland.
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, National University of Ireland, Ireland.
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork. Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork.
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Factors Associated With a Trusting Relationship Between Pregnant and Postpartum Women With Substance Use Disorders and Maternity Nurses. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-20-00018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trusting relationships between pregnant and postpartum women with substance use disorders (SUDs) and maternity nurses can improve health outcomes for women and their infants. This study was conducted to identify factors associated with the formation of trust in these nurse–patient relationships. Using a qualitative description approach, semi-structured interviews were conducted with 10 women who used substances during pregnancy and 15 maternity nurses. The narratives were analyzed with standard content analytic techniques. Findings revealed that six characteristics of nurses and five characteristics of women fostered or hindered the formation of trusting relationships. The characteristics of the maternity nurses were (a) interpersonal connections, (b) demeanor toward women, (c) ways of providing care, (d) approaches to providing information, (e) attitudes toward substance use, and (f) addiction expertise. The characteristics of the women were (a) engagement with nurses, (b) demeanor toward nurses, (c) attitudes toward care, (d) investment in recovery, and (e) ways of interacting with infant. The characteristics provide a framework by which maternity nurses can examine their attitudes and behaviors toward women with SUDs and inform the development of strategies to enhance their practice with this population.
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Cornford C, Fraser L, Wright N. Deep Vein Thromboses in Injecting Drug Users: Meanings, Bodily Experiences, and Stigma. QUALITATIVE HEALTH RESEARCH 2019; 29:1641-1650. [PMID: 31140367 DOI: 10.1177/1049732319849026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Deep vein thromboses (DVTs) are common sequelae of injecting drugs into the groin. We explored meanings and experiences of DVTs in a group of 19 patients from the North East of England with a DVT and in treatment for opioid use. We report three themes: (a) DVT meaning making, (b) embodied experience, and (c) Stigma. Patients attributed DVTs to groin injecting, though thought other factors were also partially responsible. Medication performed both treatment and preventive functions. The most pertinent worry was amputation. Patients recognized stopping injecting as important, but it did not necessarily occur. Stigma resulted in delayed admission to hospital and feelings of isolation; support groups might alleviate the latter. Although groin injecting was undertaken partly to avoid the censure of being a drug user, ironically, a DVT led to long-standing stigmata that were discrediting signs of that exact status.
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Affiliation(s)
| | - Lorraine Fraser
- 2 Starfish Health and Wellbeing Teesside, Stockton-on-Tees, United Kingdom
| | - Nat Wright
- 3 Transform Research Alliance, Wakefield, United Kingdom
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McTavish JR, Kimber M, Devries K, Colombini M, MacGregor JCD, Wathen N, MacMillan HL. Children's and caregivers' perspectives about mandatory reporting of child maltreatment: a meta-synthesis of qualitative studies. BMJ Open 2019; 9:e025741. [PMID: 30948587 PMCID: PMC6500368 DOI: 10.1136/bmjopen-2018-025741] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To systematically synthesise qualitative research that explores children's and caregivers' perceptions of mandatory reporting. DESIGN We conducted a meta-synthesis of qualitative studies. DATA SOURCES Searches were conducted in Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Criminal Justice Abstracts, Education Resources Information Center, Sociological Abstracts and Cochrane Libraries. ELIGIBILITY CRITERIA English-language, primary, qualitative studies that investigated children's or caregivers' perceptions of reporting child maltreatment were included. All healthcare and social service settings implicated by mandatory reporting laws were included. DATA EXTRACTION AND SYNTHESIS Critical appraisal of included studies involved a modified checklist from the Critical Appraisal Skills Programme (CASP). Two independent reviewers extracted data, including direct quotations from children and caregivers (first-order constructs) and interpretations by study authors (second-order constructs). Third-order constructs (the findings of this meta-synthesis) involved synthesising second-order constructs that addressed strategies to improve the mandatory reporting processes for children or caregivers-especially when these themes addressed concerns raised by children or caregivers in relation to the reporting process. RESULTS Over 7935 citations were retrieved and 35 articles were included in this meta-synthesis. The studies represent the views of 821 caregivers, 50 adults with histories of child maltreatment and 28 children. Findings suggest that children and caregivers fear being reported, as well as the responses to reports. Children and caregivers identified a need for improvement in communication from healthcare providers about mandatory reporting, offering preliminary insight into child-driven and caregiver-driven strategies to mitigate potential harms associated with reporting processes. CONCLUSION Research on strategies to mitigate potential harms linked to mandatory reporting is urgently needed, as is research that explores children's experiences with this process.
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Affiliation(s)
- Jill R McTavish
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Devries
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Manuela Colombini
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer C D MacGregor
- Faculty of Information & Media Studies, The University of Western Ontario, London, Ontario, Canada
| | - Nadine Wathen
- Faculty of Information & Media Studies, The University of Western Ontario, London, Ontario, Canada
| | - Harriet L MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Pochard L, Dupouy J, Frauger E, Giocanti A, Micallef J, Lapeyre-Mestre M. Impact of pregnancy on psychoactive substance use among women with substance use disorders recruited in addiction specialized care centers in France. Fundam Clin Pharmacol 2018; 32:188-197. [PMID: 29337399 DOI: 10.1111/fcp.12346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/04/2017] [Accepted: 12/22/2017] [Indexed: 01/23/2023]
Abstract
Pregnancy can be a motivation for decrease in drug abusing but may also represent a period of high vulnerability for relapse. We aimed to assess psychoactive substance use among women with substance use disorders followed in addiction care centers in France. We analyzed data from women aged 15-44 years included in the 'Observation of illegal drugs and misuse of psychotropic medication (OPPIDUM) survey', an annual cross-sectional survey collecting details on psychoactive substances used. Characteristics of women included in 2005-2012 yearly surveys were compared depending on their pregnant or not pregnant status. Factors, including pregnancy, associated with illicit substance use and medication misuse were investigated through logistic regression. The study included 518 pregnant and 6345 nonpregnant women; 85.3% pregnant women were on opioid maintenance therapy (OMT) (vs. 77.1% of nonpregnant). Pregnancy was associated with lower illicit substance use (adjusted OR 0.71 [0.58-0.88]) and with lower medication misuse (0.66 [0.49-0.89]), whereas financial insecurity and living as a couple were associated with increased risk. Raising children was significantly associated with less risk of substance use. Each substance taken separately, the part of women using illicit substance or misusing medication did not differ depending on whether they were pregnant or not, except for heroin (24.5% in pregnant vs. 17.9% nonpregnant; <0.001). This nationwide study provides new insights into psychoactive substance use in a large mixed population of women with drug use disorders. Results outline the challenge of preventing drug use and initiating care strategies with a specific approach on socio-economic environment.
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Affiliation(s)
- Liselotte Pochard
- Service de Pharmacologie Clinique, Faculté de Médecine, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance de Toulouse, CHU de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodépendance Paca Corse, Hôpital de la Timone, 13005, Marseille, France
| | - Julie Dupouy
- Faculté de Médecine, UMR Inserm 1027, Université Toulouse 3, 37 Allées Jules Guesde, 31073, Toulouse Cedex, France
| | - Elisabeth Frauger
- Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodépendance Paca Corse, Hôpital de la Timone, 13005, Marseille, France.,Institut de Neurosciences de la Timone, UMR 7289 CNRS, Aix-Marseille Université, Campus Timone, 13005, Marseille, France
| | - Adeline Giocanti
- Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodépendance Paca Corse, Hôpital de la Timone, 13005, Marseille, France
| | - Joëlle Micallef
- Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodépendance Paca Corse, Hôpital de la Timone, 13005, Marseille, France.,Institut de Neurosciences de la Timone, UMR 7289 CNRS, Aix-Marseille Université, Campus Timone, 13005, Marseille, France
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Clinique, Faculté de Médecine, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance de Toulouse, CHU de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine, UMR Inserm 1027, Université Toulouse 3, 37 Allées Jules Guesde, 31073, Toulouse Cedex, France
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MELO MC, CORRADI-WEBSTER CM. Meanings about mothering by women in treatment for drug use. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2016. [DOI: 10.1590/1982-02752016000400013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract There is a growing number of women who use drugs. Furthermore, the responsibility for family care is still attributed solely to women. This study aimed to describe the meanings constructed regarding mothering by women in treatment for drug use. This qualitative and descriptive study, with a social constructionist intelligibility, was developed with women in treatment at the Centro de Atenção Psicosocial - Álcool e Drogas of Ribeirão Preto, Brazil. Eight life story thematic interviews were carried out. The analysis resulted in four themes: 1) Mothering as the woman's choice; 2) Learning with drug consumption experiences and using this to warn and educate children; 3) Drug consumption interfering in mothering and 4) Drug consumption understood in different ways throughout the treatment. The meanings attributed to mothering consist of moral and gender discourses regarding the responsibilities attributed to women and the difficulties solely attributed to their drug use.
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Tucker Edmonds B, Mckenzie F, Austgen MB, Carroll AE, Meslin EM. Women’s opinions of legal requirements for drug testing in prenatal care. J Matern Fetal Neonatal Med 2016; 30:1693-1698. [DOI: 10.1080/14767058.2016.1222369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | - Aaron E. Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA, and
| | - Eric M. Meslin
- Center for Bioethics, Indiana University, Indianapolis, IN, USA
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Abstract
AIM To report an analysis of the concept of risk perception in pregnancy. BACKGROUND Pregnant women are increasingly exposed to the view that pregnancy and childbirth are intrinsically dangerous, requiring medical monitoring and management. Societal pressures are applied to women that dictate appropriate behaviours during pregnancy. These changes have resulted in increased perception of risk for pregnant women. DESIGN Walker and Avant's method was selected to guide this analysis. DATA SOURCES Peer-reviewed articles published in English from CINAHL, Scopus, PubMed and Psychinfo. No date limits were applied. METHODS Thematic analysis was conducted on 79 articles. Attributes, antecedents and consequences of the concept were identified. RESULTS The attributes of the concept are the possibility of harm to mother or infant and beliefs about the severity of the risk state. The physical condition of pregnancy combined with the cognitive ability to perceive a personal risk state is antecedents. Risk perception in pregnancy influences women's affective state and has an impact on decision-making about pregnancy and childbirth. There are limited empirical referents with which to measure the concept. CONCLUSION Women today know more about their developing infant than at any other time in history; however, this has not led to a sense of reassurance. Nurses and midwives have a critical role in assisting pregnant women, and their families make sense of the information they are exposed to. An understanding of the complexities of the concept of risk perception in pregnancy may assist in enabling nurses and midwives to reaffirm the normalcy of pregnancy.
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Affiliation(s)
- Suzanne Lydia Lennon
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Benoit C, Magnus S, Phillips R, Marcellus L, Charbonneau S. Complicating the dominant morality discourse: mothers and fathers' constructions of substance use during pregnancy and early parenthood. Int J Equity Health 2015; 14:72. [PMID: 26303942 PMCID: PMC4548907 DOI: 10.1186/s12939-015-0206-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Consumption of substances is a highly controversial behaviour, with those who do so commonly viewed as deviants, even criminals, or else as out of control addicts. In other work we showed that the use of substances by women who are pregnant or have recently become parents was mainly viewed by health and social care providers as morally wrong. Problematic substance use was framed through the narrow lens of gendered responsibilisation, resulting in women being seen primarily as foetal incubators and primary caregivers of infants. Methods In this follow-up paper we examine descriptive and qualitative data from a convenience sample of biological mothers and fathers (N = 34) recruited as part of a larger mixed methods study of the development and early implementation of an integrated primary maternity care program. We present a description of the participants’ backgrounds, family circumstances, health status, and perception of drug-related stigma. This is succeeded by a thematic analysis of their personal views on substance use during both pregnancy and the transition to parenthood. Results Our results show that while many mothers and fathers hold abstinence as the ideal during pregnancy and early parenting, they simultaneously recognize the autonomy of women to judge substance use risk for themselves. Participants also call attention to social structural factors that increase/decrease harms associated with such substance use, and present an embodied knowledge of substance use based on their tacit knowledge of wellness and what causes harm. Conclusions While these two main discourses brought forward by parents concerning the ideal of abstinence and the autonomy of women are not always reconcilable and are partially a reflection of the dissonance between dominant moral codes regarding motherhood and the lived experiences of people who use substances, service providers who are attuned to these competing discourses are likely to be more effective in their delivery of health and social services for vulnerable families. More holistic and nuanced perspectives of health, substance use, and parenting may generate ethical decision-making practice frameworks that guide providers in meeting and supporting the efforts of mothers and fathers to achieve well-being within their own definitions of problematic substance use.
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Affiliation(s)
- Cecilia Benoit
- Centre for Addictions Research of BC and Department of Sociology, University of Victoria, PO Box 3050, Victoria, V8W3P5, BC, Canada.
| | - Samantha Magnus
- School of Public Health and Social Policy, University of Victoria, PO Box 1700, Victoria, V8W2Y2, BC, Canada.
| | - Rachel Phillips
- Centre for Addictions Research of BC, Centre for Addictions Research of BC, Victoria, Canada.
| | - Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700, Victoria, V8W-2Y2, BC, Canada.
| | - Sinéad Charbonneau
- Faculty of Law, University of Toronto, #1- 328 Arlington Ave, Toronto, M6C2Z9, ON, Canada.
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O'Connor A, Lewis L, McLaurin R, Barnett L. Maternal and neonatal outcomes of Hepatitis C positive women attending a midwifery led drug and alcohol service: A West Australian perspective. Midwifery 2015; 31:793-7. [PMID: 25957760 DOI: 10.1016/j.midw.2015.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 04/09/2015] [Accepted: 04/11/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND the Women and Newborn Drug and Alcohol Service (WANDAS) is a specialist, midwifery-led service providing pregnancy care to women dealing with alcohol and other drug (AOD) use, at the sole tertiary maternity hospital in Western Australia. AIM to assess the antenatal, intrapartum and neonatal outcomes of women with Hepatitis C (HCV) who attended the WANDAS service between 2009 and 2012. DESIGN this retrospective cohort study used data obtained from computerised midwifery records. Univariate comparisons between those who were HCV positive and those who were not, were performed. Multivariable logistic regression was utilised to investigate the simultaneous factors associated with being HCV positive and an opiate user. FINDINGS the incidence of HCV in this cohort was 37% (213 of 570). Compared to those who were HCV negative those who were positive were more likely to: be older (P<0.001); use opioids in pregnancy (P<0.001); be an intravenous drug user (P<0.001); engage in polysubstance use (P<0.001); and receive an induction of labour (P=0.036). There were no intrapartum characteristics found to be significant at a multivariate level associated with being HCV positive and an opiate user, but there were a couple of neonatal complications. These were having a baby admitted to Special Care Nursery (OR 1.95, 95% CI 1.33-2.88, P<0.001) and a baby at increased risk of being diagnosed with neonatal abstinence syndrome (OR 3.40, 95% CI 2.24-5.15, P<0.001). CONCLUSION our findings highlight the complexity of caring for pregnant women who are HCV positive, they also highlight that all pregnant women who are AOD users are an at risk population. IMPLICATIONS FOR PRACTICE these results improve our understanding of the obstetric and midwifery issues associated with caring for pregnant women who are HCV positive and the value of provision of specialist care from a multidisciplinary team, led by a consultant midwife.
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Affiliation(s)
- Angela O'Connor
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia. angela.o'
| | - Lucy Lewis
- School of Nursing and Midwifery, Curtin University, Western Australia, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
| | - Renate McLaurin
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
| | - Lisa Barnett
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
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Raitasalo K, Holmila M, Autti-Rämö I, Martikainen JE, Sorvala VM, Mäkelä P. Benzodiazepine use among mothers of small children: a register-based cohort study. Addiction 2015; 110:636-43. [PMID: 25407572 DOI: 10.1111/add.12808] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/28/2014] [Accepted: 11/11/2014] [Indexed: 11/28/2022]
Abstract
AIMS To compare benzodiazepine (BZD) purchases in different groups of mothers of small children. DESIGN Prospective population-based cohort study based on the Finnish social and health care registers. SETTING Finnish women of child-bearing age. PARTICIPANTS All women who gave birth in 2002 in Finland (n = 54 519). MEASUREMENTS Latent class analysis (LCA) was used to create a typology of mothers according to their substance abuse status, psychiatric disorders and socio-demographic characteristics. The mothers were followed-up yearly for purchases of benzodiazepines, starting 4 years before the child's birth and continuing up to the child's 7th birthday. BZD purchases in different mother groups were compared using negative binomial hurdle models. FINDINGS The five mother types identified by LCA were mothers with substance abuse (1%), mothers with psychiatric disorders (1%), mothers with a risk of social marginalization (11%), mothers with minor social problems (18%) and mothers with no identified problems (69%; the comparison group). Mothers with substance abuse problems had the highest odds of purchasing BZDs [odds ratio OR = 27.5, 95%CI = 22.9-33.0; RR = 20.2, 95%CI = 14.9-27.3. The change in time was similar in all groups: the probability of purchasing and the number of purchases were lowest during pregnancy and the year of the child's birth. CONCLUSIONS In Finland, among mothers of young children, prevalence of benzodiazepine use is reduced during pregnancy and the child's first year, and then increases as the child grows older. Mothers with substance abuse and psychiatric disorders are at particularly high risk of benzodiazepine use.
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Contraceptive use and pregnancy outcomes among opioid drug-using women: a retrospective cohort study. PLoS One 2015; 10:e0116231. [PMID: 25739018 PMCID: PMC4349816 DOI: 10.1371/journal.pone.0116231] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 12/05/2014] [Indexed: 12/29/2022] Open
Abstract
Objective The contraceptive needs of illicit opioid users differ from non-drug users but are poorly understood. The aim of this study was to describe contraceptive use and pregnancy outcomes in opioid-using women, and to examine their association with a range of risk factors. Method This retrospective cohort study used UK general practice records, Treatment Outcomes Profile and National Drug Treatment Monitoring System data, and a nested data validation exercise. A cohort of 376 women aged 20–61 years were in active treatment for opioid addiction in October 2010 at two specialised primary care practices in North-East England. Outcomes were age-adjusted prevalence estimates for contraceptive use and pregnancy outcomes in users of illicit opioids. The association between lifestyle-related risk factors and contraception was explored. Results Drug-using women made lower use of planned (non-condom) contraception (24% vs 50%, p<0.001), had more frequent pregnancy terminations (0.46 vs. 0.025, p = 0.004) and higher annual incidence of chlamydia (1.1% vs. 0.33%, p<0.001), when compared with age-matched population data. Specifically, there was low use of oral contraceptives (4% vs. 25%, p<0.001), IUCD (1% vs. 6%, p<0.001), and sterilisation (7% vs. 6%, p = 0.053), but higher rates of injectable contraceptives (6% vs. 3%, p = 0.003). A total of 64% of children aged <16 years born to this group did not live with their mother. No individual risk factor (such as sex-working) significantly explained the lower use or type of non-condom contraception. Conclusions This is the first study to describe planned contraceptive use among drug-users, as well as the association with a range of risk factors and pregnancy outcomes. The low uptake of planned contraception, set against high rates of terminations and sexually transmitted disease demonstrates the urgent clinical need to improve contraceptive services, informed by qualitative work to explore the values and beliefs influencing low contraceptive uptake.
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Substance, structure and stigma: Parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periods. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:e35-42. [DOI: 10.1016/j.drugpo.2013.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/18/2013] [Accepted: 04/10/2013] [Indexed: 11/23/2022]
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