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Backer KD, Rayment-Jones H, Lever Taylor B, Bicknell-Morel T, Montgomery E, Sandall J, Easter A. Healthcare experiences of pregnant and postnatal women and healthcare professionals when facing child protection in the perinatal period: A systematic review and Critical Interpretative Synthesis. PLoS One 2024; 19:e0305738. [PMID: 38959192 PMCID: PMC11221698 DOI: 10.1371/journal.pone.0305738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND The perinatal period is known as time of transition and anticipation. For women with social risk factors, child protection services may become involved during the perinatal period and this might complicate their interactions with healthcare providers. AIM To systematically review and synthesise the existing qualitative evidence of healthcare experiences of women and healthcare professionals during the perinatal period while facing child protection involvement. METHODS A systematic search of databases (Web of Science, MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, MIDIRS, Social Policy and Practice and Global Health) was carried out in January 2023, and updated in February 2024. Quality of studies was assessed using the Critical Appraisal Skills Programme. A Critical Interpretative Synthesis was used alongside the PRISMA reporting guideline. RESULTS A total of 41 studies were included in this qualitative evidence synthesis. We identified three types of healthcare interactions: Relational care, Surveillance and Avoidance. Healthcare interactions can fluctuate between these types, and elements of different types can coexist simultaneously, indicating the complexity and reciprocal nature of healthcare interactions during the perinatal period when child protection processes are at play. CONCLUSIONS Our findings provide a novel interpretation of the reciprocal interactions in healthcare encounters when child protection agencies are involved. Trust and transparency are key to facilitate relational care. Secure and appropriate information-sharing between agencies and professionals is required to strengthen healthcare systems. Healthcare professionals should have access to relevant training and supervision in order to confidently yet sensitively safeguard women and babies, while upholding principles of trauma-informed care. In addition, systemic racism in child protection processes exacerbate healthcare inequalities and has to be urgently addressed. Providing a clear framework of mutual expectations between families and healthcare professionals can increase engagement, trust and accountability and advance equity.
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Affiliation(s)
- Kaat De Backer
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
| | - Hannah Rayment-Jones
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
| | - Billie Lever Taylor
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | | | - Elsa Montgomery
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Jane Sandall
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
| | - Abigail Easter
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
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Taylor A, Whittaker A, Chandler A, Carnegie E. Accounts of women identified as drinking at 'high risk' during pregnancy: A meta-ethnography of missing voices. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104061. [PMID: 37245246 DOI: 10.1016/j.drugpo.2023.104061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/25/2023] [Accepted: 05/07/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Drinking alcohol during pregnancy is associated with Foetal Alcohol Spectrum Disorders (FASD), and women who drink at higher levels are more likely to have a baby with FASD. Public health responses focus on population-level approaches to FASD prevention such as promoting abstinence and alcohol brief interventions. Efforts to better understand and respond to 'high risk' drinking during pregnancy have been largely ignored. This meta-ethnography of qualitative research aims to inform this policy and practice agenda. METHODS Ten health, social care, and social sciences databases were searched for qualitative studies published since 2000 exploring drinking during pregnancy. Studies that included accounts of women who described themselves, or were diagnosed as, alcohol-dependent during pregnancy, or reported drinking during pregnancy at levels considered by the Word Health Organisation to constitute 'high risk' drinking, were eligible. Noblit and Hare's analytic approach to meta-ethnography was used to synthesise the studies and eMERGe reporting guidance was followed. RESULTS Nine diverse studies were included. All explored the impact of social norms and relationships, women's knowledge about the risks involved in drinking during pregnancy, the behaviour of women, and the advice they received. Three key themes were identified: drinking is social and relational, knowledge is not enough, and multiple adversities matter. Multiple adversities were interconnected and primarily related to structural inequalities and oppression. The complex needs of women and the wider context in which their drinking occurred were rarely explored or responded to during pregnancy. CONCLUSION This meta-ethnography provides a more nuanced understanding of the complex dynamics involved in women's 'high risk' drinking during pregnancy, the contexts in which they drink and their unmet needs. These findings can inform future policy and practice responses to 'high risk' drinking during pregnancy. Further research should explore women's experiences in a UK context and consider how services could meet women's needs.
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Affiliation(s)
- Annie Taylor
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill, Edinburgh EH11 4BN, UK.
| | - Anne Whittaker
- NMAHP Research Unit, Faculty of Health Sciences and Sport, Pathfoot Building, University of Stirling, Stirling, Scotland, FK9 4LA, UK
| | - Amy Chandler
- School of Health in Social Science, University of Edinburgh, EH8 9AG, UK
| | - Elaine Carnegie
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Sighthill, Edinburgh EH11 4BN, UK
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Corbett GA, Carmody D, Rochford M, Cunningham O, Lindow SW, O'Connell MP. Drug use in pregnancy in Ireland's capital city: A decade of trends and outcomes. Eur J Obstet Gynecol Reprod Biol 2023; 282:24-30. [PMID: 36621262 DOI: 10.1016/j.ejogrb.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/17/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to present contemporary trends in opiate use disorder (OUD) and substance use in pregnancy in Ireland, with associated obstetric outcomes, over the last ten years. STUDY DESIGN This retrospective observational cohort study was conducted at an Irish tertiary maternity unit. All women with OUD or substance use in pregnancy delivered under this service between 2010 and 2019 were included. Drug-exposure was self-reported. Data was collected by combining electronic and hand-held patient records. Trends and outcomes were analysed by year of delivery. Approval for the study was granted by the institution's clinical governance committee. RESULTS Of the 82,669 women delivered, 525 had OUD or substance use in pregnancy (1 in every 160 women booking). 11.6% were homeless, 20.0% were in full-time employment and 91.0% smoked tobacco in pregnancy. 66.3% had a history of psychiatric disorders. Over the ten years, there was a significant reduction in women delivered with OUD or substance use in pregnancy (0.8 % to 0.4 %, RR 0.55, 95 % CI 0.36-0.85), significant reduction in the proportion of women on Opioid-Substitute-Treatment (OST, RR 0.66 95 % CI 0.51-0.87) and an increase in mean maternal age (30.7to32.0 years). Rates of cocaine and cannabis consumption increased (20.6 %, RR 3.8, 95 % CI 1.57-9.44: 24.0 %, RR 3.7, 95 % CI 1.58-8.86 respectively). The maternal mortality rate was 380.9:100,000 births. The perinatal mortality rate was 15.6:1000 births. The preterm birth rate was 17.9 %, with a mean birth weight of 2832 g. The rate of NICU admission was 52.0 % and the mean length of stay was 22.4 days. Amongst the smaller OUD population, the rate of NICU admission for Neonatal Abstinence Syndrome (NAS) and treatment for NAS increased over the study timeframe (36.0 %, RR 2.97, 95 % CI 1.86-4.75: 28.5 %, RR 2.92, 95 % CI 1.70-5.0 respectively). CONCLUSIONS The obstetric population attending an Irish antenatal service with opiate use disorder or substance exposure is reducing in size with older patients, less opioid substitute therapy and increasing cocaine and cannabis use. These women have high rates of maternal and perinatal morbidity and mortality. Specialist antenatal addiction services, coordinated by the drug-liaison midwife, are critical in adapting care to respond to this dynamic and vulnerable patient cohort.
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Affiliation(s)
- Gillian A Corbett
- Coombe Women and Infants University Hospital, Dublin, Ireland; University College Dublin, Ireland.
| | - Deirdre Carmody
- Addiction Service, Health Service Executive Dublin South, Kildare and West Wicklow Healthcare, Ireland
| | - Marie Rochford
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Orla Cunningham
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - Michael P O'Connell
- Coombe Women and Infants University Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, University of Medicine and Health Sciences Dublin, Ireland
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Tappin D, Mackay D, Reynolds L, Fitzgerald N. Minimizing sample bias due to stigmatized behaviours: the representativeness of participants in a cohort study of alcohol in pregnancy. BMC Med Res Methodol 2022; 22:138. [PMID: 35562676 PMCID: PMC9107203 DOI: 10.1186/s12874-022-01629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 04/29/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Stigmatized behaviours are often underreported, especially in pregnancy, making them challenging to address. The Alcohol and Child Development Study (ACDS) seeks to inform prevention of foetal alcohol harm, linking self-report as well as a maternal blood alcohol biomarker with child developmental outcomes. Samples were requested using passive, generic consent. The success of this approach at minimizing bias is presented comparing characteristics of women who provided samples to those who did not. METHODS All pregnant women in the study city were sent a Patient Information Sheet (PIS) with their first NHS obstetric appointment letter. The PIS informed them that the NHS would like to take an extra blood sample for research purposes, unless they opted out. Neither the women nor the midwives were informed that the samples might be tested for an alcohol biomarker. This paper examines the extent to which women who provided the extra sample were representative of women where no sample was provided, in terms of routinely collected information: age; body mass index; area-based deprivation; previous pregnancies, abortions and caesarians; smoking status and carbon monoxide level; self-reported alcohol use, gestation and birth weight of their baby. Chi-square and Mann-Whitney U tests were used to compare groups. RESULTS 3436 (85%) of the 4049 pregnant women who attended their appointment provided the extra sample. Women who did not were significantly younger (p < 0.001), more materially deprived (p < 0.001), and less likely to be considered for intervention based on self-reported alcohol use (p < 0.001). There were no significant differences between the two groups on other routine data. CONCLUSIONS The use of passive consent without disclosure of the specific research focus resulted in a high level of sample provision. There was no evidence that study blinding was breached, and women who provided a sample were more likely to report alcohol consumption. Passive consent to draw additional blood for research purposes at routine antenatal venipuncture reduced sampling bias compared to asking women to give blood for an alcohol study. This methodology may be useful for other stigmatised behaviours.
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Affiliation(s)
- David Tappin
- grid.8756.c0000 0001 2193 314XSection of Child Health, College of Medical, Veterinary & Life Sciences, Wolfson Medical School Building, University of Glasgow, 31, Shawhill Road, Glasgow, Scotland G41 3RW UK
| | - Daniel Mackay
- grid.8756.c0000 0001 2193 314XInstitute of Health and Wellbeing, Public Health, University of Glasgow, 1 Lilybank Gardens, Glasgow, Scotland G12 8RZ UK
| | - Lucy Reynolds
- grid.413301.40000 0001 0523 9342NHS Greater Glasgow & Clyde Health Board, Community Child Health, Children’s Services, Woodside Health and Care Centre, 891 Garscube Road, Glasgow, G20 7ER UK
| | - Niamh Fitzgerald
- grid.11918.300000 0001 2248 4331Institute for Social Marketing & Health, Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA UK ,SPECTRUM Consortium, Edinburgh, UK
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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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Barriers to women's disclosure of and treatment for substance use during pregnancy: A qualitative study. Women Birth 2021; 35:576-581. [PMID: 34969637 DOI: 10.1016/j.wombi.2021.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/26/2021] [Accepted: 12/22/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The use of alcohol and or illicit drugs during pregnancy is a complex public health issue. There are many adverse short- and long-term health implications of substance use during pregnancy that can potentially affect the mother-foetal dyad. Although prevention and treatment options - such as counselling, pharmacotherapy, rehabilitation, support and case management and withdrawal management - are available, a range of barriers impedes women's ability to disclose their substance use, which limits access and engagement with available services. OBJECTIVE This research explored barriers women encountered in disclosing substance use and accessing substance use treatment in pregnancy. METHODS Participants were recruited from a longitudinal cohort study of people with a history of injecting drug use from metropolitan Melbourne. One-on-one in-depth interviews with 15 participants were conducted using a semi-structured interview guide. To be included in this study, participants must have reported a history of substance use during one or more of their pregnancies. RESULTS The fear of losing child custody associated with the involvement of the child protection services was one of the main barriers to disclosing substance use during pregnancy and accessing treatment and rehabilitation services. Other barriers including stigma and perceived limited treatment options impacted women in various ways. CONCLUSION Pregnancy is an important time for women and offers opportunities for service providers to support women who are using substances. While not all barriers can be removed, careful consideration of individual cases and circumstances may help service providers to tailor interventions that are likely to be more successful.
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Nurses' Descriptions of Interactions When Caring for Women With Perinatal Substance Use Disorders and Their Infants. Nurs Womens Health 2021; 25:366-376. [PMID: 34478736 DOI: 10.1016/j.nwh.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/02/2021] [Accepted: 07/22/2021] [Indexed: 01/15/2023]
Abstract
The purpose of this review is to describe health care interactions between nurses and women with perinatal substance use disorders, including interactions with their infants from the perspective of the nurses. Findings from 11 qualitative inclusion articles were synthesized using a metasummary approach. The majority of articles showed that nurses experience problematic interactions when providing care to women with perinatal substance use disorders and their infants, although some results indicated that some nurses engage in interactions that are assuring. Six types of conflictual interactions were identified: inadequate care, distressing, condemning, deficient knowledge, rejecting, and dissatisfying. Two types of therapeutic interactions were identified: compassionate and supportive. The findings underscore the importance of managing stigma, enhancing knowledge of the science of addiction processes, and promoting best practices when caring for this population.
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Patel E, Bandara S, Saloner B, Stuart EA, Goodman D, Terplan M, McCourt A, White S, McGinty EE. Heterogeneity in prenatal substance use screening despite universal screening recommendations: findings from the Pregnancy Risk Assessment Monitoring System, 2016-2018. Am J Obstet Gynecol MFM 2021; 3:100419. [PMID: 34116233 DOI: 10.1016/j.ajogmf.2021.100419] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The American College of Obstetricians and Gynecologists recommends universal screening for tobacco, alcohol, and drug use as a part of routine prenatal care. However, little is known about the prevalence of prenatal substance use screening or factors that may contribute to differential rates of screening during prenatal care. OBJECTIVE This study aimed to describe the prevalence of prenatal substance use screening by substance, year, state, and state-level prenatal substance use policies and to examine individual-level factors associated with receipt of screening. STUDY DESIGN We analyzed 2016 to 2018 data from 103,608 women participating in the Pregnancy Risk Assessment Monitoring System, a population-based survey among women with recent live births. The Pregnancy Risk Assessment Monitoring System survey sampling weights were applied to all analyses. We described the percentage of individuals asked by a healthcare worker about substance use during a prenatal care appointment by substance, year, and state. Using chi-squared tests, we examined differences in the prevalence of screening by state-level prenatal substance use policies, including policies regarding classification of prenatal substance use as child abuse or neglect, mandatory testing or reporting of prenatal substance use, and targeted treatment funding and access for pregnant individuals with substance use disorders. Finally, we estimated the association between individual-level characteristics and receipt of prenatal substance use screening using logistic regression, controlling for year and state fixed effects and accounting for missingness using multiple imputation. RESULTS In 2018, approximately 95% individuals reported being asked about cigarette or alcohol use during a prenatal care appointment, whereas only 80% reported being asked about drug use. The percentage of individuals who were asked about substance use during a prenatal care appointment increased overall between 2016 and 2018, with variability across states. For all substances, states with laws designating prenatal drug use as child abuse or neglect had lower prevalence of screening, whereas states with laws mandating providers to test for substance use in pregnancy had higher prevalence of screening. Several individual-level characteristics were associated with increased odds of reported prenatal substance use screening for one or more substances, including being younger, less educated, unmarried, Black (vs White), non-Hispanic, or publicly insured (vs privately insured), receiving adequate prenatal care, and having a history of prepregnancy cigarette use. CONCLUSION Our study finds that despite recommendations for universal prenatal substance use screening, there are differences in who is actually asked about substance use during prenatal care appointments. This may be influenced by state-level prenatal substance use policies and selective screening approaches in which certain individuals are more likely to be asked about substance use during their prenatal care appointment. A better understanding of the repercussions of selective screening approaches on outcomes and the roles that policies, systems, and provider biases play in perpetuating these approaches is needed to advance guideline implementation efforts in prenatal care settings.
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Affiliation(s)
- Esita Patel
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute.
| | - Sachini Bandara
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Brendan Saloner
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Elizabeth A Stuart
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Daisy Goodman
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Mishka Terplan
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Alexander McCourt
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Sarah White
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Emma E McGinty
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
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Mc Elhinney H, Taylor BJ, Sinclair M. Judgements of health and social care professionals on a child protection referral of an unborn baby: Factorial survey. CHILD ABUSE & NEGLECT 2021; 114:104978. [PMID: 33582402 DOI: 10.1016/j.chiabu.2021.104978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Midwives and children's services social workers have responsibilities to identify and support pregnant women where there are child protection concerns. Professionals seek to anticipate the risk of harm and initiate interventions to provide support to families. There is little research on how professionals prioritise risk factors and the challenges they face in protecting unborn babies. OBJECTIVE To measure the impact of identified risk factors regarding child protection referrals of unborn babies on the professional judgements of midwives and children's services social workers. METHODS A factorial survey design using vignettes with randomised factors within a standardised structure, administered digitally using Qualtrics software. PARTICIPANTS & SETTING Midwives (n = 250) and children's services social workers (n = 88) from one Health and Social Care Trust in Northern Ireland. RESULTS One thousand and ninety-six vignettes were completed by 118 participants. Analysis using multiple regression showed that the risk factors together accounted for 44% of the variance in perceived risk of harm and of the variance on perceived need for a referral. The significant Independent Variables (IVs) in order included: drug use, alcohol use, age, antenatal care attendance, mental wellbeing, domestic violence and the pregnant woman's I the childhood experiences. There were no significant differences between midwives and social workers regarding judgements about important risk factors. CONCLUSIONS This survey provided an ordering of major risk factors influencing decision making to protect an unborn baby from the perspective of experienced social workers and midwives. The study helps professionals in judging the seriousness of risk factors. The interaction effects between risks requires further research.
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Affiliation(s)
- Helena Mc Elhinney
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University, Coleraine, UK.
| | - Brian J Taylor
- School of Applied Social & Policy Sciences, Ulster University, Coleraine, UK.
| | - Marlene Sinclair
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University, Coleraine, UK.
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Smith LA, Dyson J, Watson J, Schölin L. Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives. BMC Pregnancy Childbirth 2021; 21:134. [PMID: 33588774 PMCID: PMC7885406 DOI: 10.1186/s12884-021-03583-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background In 2016, the UK Chief Medical Officers revised their guidance on alcohol and advised women to abstain from alcohol if pregnant or planning pregnancy. Midwives have a key role in advising women about alcohol during pregnancy. The aim of this study was to investigate UK midwives’ practices regarding the 2016 Chief Medical Officers Alcohol Guidelines for pregnancy, and factors influencing their implementation during antenatal appointments. Methods Online cross-sectional survey of a convenience sample of UK midwives recruited through professional networks and social media. Data were gathered using an anonymous online questionnaire addressing knowledge of the 2016 Alcohol Guidelines for pregnancy; practice behaviours regarding alcohol assessment and advice; and questions based on the Theoretical Domains Framework (TDF) to evaluate implementation of advising abstinence at antenatal booking and subsequent antenatal appointments. Results Of 842 questionnaire respondents, 58% were aware of the 2016 Alcohol Guidelines of whom 91% (438) cited abstinence was recommended, although 19% (93) cited recommendations from previous guidelines. Nonetheless, 97% of 842 midwives always or usually advised women to abstain from alcohol at the booking appointment, and 38% at subsequent antenatal appointments. Mean TDF domain scores (range 1–7) for advising abstinence at subsequent appointments were highest (indicative of barriers) for social influences (3.65 sd 0.84), beliefs about consequences (3.16 sd 1.13) and beliefs about capabilities (3.03 sd 073); and lowest (indicative of facilitators) for knowledge (1.35 sd 0.73) and professional role and identity (1.46 sd 0.77). Logistic regression analysis indicated that the TDF domains: beliefs about capabilities (OR = 0.71, 95% CI: 0.57, 0.88), emotion (OR = 0.78; 95%CI: 0.67, 0.90), and professional role and identity (OR = 0.69, 95%CI 0.51, 0.95) were strong predictors of midwives advising all women to abstain from alcohol at appointments other than at booking. Conclusions Our results suggest that skill development and reinforcement of support from colleagues and the wider maternity system could support midwives’ implementation of alcohol advice at each antenatal appointment, not just at booking could lead to improved outcomes for women and infants. Implementation of alcohol care pathways in maternity settings are beneficial from a lifecourse perspective for women, children, families, and the wider community. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03583-1.
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Affiliation(s)
- Lesley A Smith
- Institute of Clinical and Applied Health Research, Faculty of Health Sciences, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
| | - Judith Dyson
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Julie Watson
- Care Quality Commission, Citygate, Gallowgate, Newcastle Upon Tyne, NE1 4PA, UK
| | - Lisa Schölin
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
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Schölin L, Fitzgerald N. The conversation matters: a qualitative study exploring the implementation of alcohol screening and brief interventions in antenatal care in Scotland. BMC Pregnancy Childbirth 2019; 19:316. [PMID: 31481011 PMCID: PMC6724251 DOI: 10.1186/s12884-019-2431-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022] Open
Abstract
Background Alcohol screening and brief intervention (SBI) in antenatal care is internationally recommended to prevent harm caused by alcohol exposure during pregnancy. There is, however, limited understanding of how SBI is implemented within antenatal care; particularly the approach taken by midwives. This study aimed to explore the implementation of a national antenatal SBI programme in Scotland. Methods Qualitative interviews were conducted with antenatal SBI implementation leaders (N = 8) in eight Scottish health boards. Interviews were analysed thematically and using the ‘practical, robust implementation and sustainability model’ (PRISM) to understand differences in implementation across health boards and perceived setting-specific barriers and challenges. Results In several health boards, where reported maternal alcohol use was lower than expected, implementation leaders sought to optimize enquires about women’s alcohol use to facilitate honest disclosure. Strategies focused on having positive conversations, exploring pre-pregnancy drinking habits, and building a trusting relationship between pregnant women and midwives. Women’s responses were encouraging and disclosure rates appeared improved, though with some unexpected variation over time. Adapting the intervention to the local context was also considered important. Conclusions This is the first study to explore implementation leaders’ experiences of antenatal SBI delivery and identify possible changes in disclosure rates arising from the approach taken. In contrast with current antenatal alcohol screening recommendations, a conversational approach was advocated to enhance the accuracy and honesty of reporting. This may enable provision of support to more women to prevent Fetal Alcohol Spectrum Disorders (FASD) and will therefore be of international interest.
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Affiliation(s)
- Lisa Schölin
- School of Health in Social Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Niamh Fitzgerald
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA, UK.
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Schölin L, Hughes K, Bellis MA, Eriksson C, Porcellato L. “I think we should all be singing from the same hymn sheet” – English and Swedish midwives’ views of advising pregnant women about alcohol. DRUGS: EDUCATION, PREVENTION AND POLICY 2019. [DOI: 10.1080/09687637.2018.1478949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lisa Schölin
- Liverpool John Moores Unviersity, Public Health Institute, Henry Cotton Campus, Liverpool, UK
| | - Karen Hughes
- Public Health Wales Directorate of Policy Research and International Development Public Health Wales, Wrexham, UK
- Bangor University College of Health and Behavioural Sciences, Bangor, UK
| | - Mark A. Bellis
- Public Health Wales Directorate of Policy Research and International Development Public Health Wales, Wrexham, UK
- Bangor University College of Health and Behavioural Sciences, Bangor, UK
| | - Charli Eriksson
- School of Health and Medical Sciences, Örebro Universitet, Örebro, Sweden
| | - Lorna Porcellato
- Liverpool John Moores Unviersity, Public Health Institute, Henry Cotton Campus, Liverpool, UK
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Howell MP, Smith AM, Lindsay EB, Drury SS. Understanding barriers to timely identification of infants at risk of neonatal opiate withdrawal syndrome. J Matern Fetal Neonatal Med 2019; 34:1161-1166. [PMID: 31195865 DOI: 10.1080/14767058.2019.1627316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neonatal opiate withdrawal syndrome (NOWS), previously known as neonatal abstinence syndrome (NAS), is a growing public health concern as opiate misuse and opioid-related overdoses, from both prescription and illicit sources, continue to rise in the USA. As more than 90% of females abusing opioids are of child-bearing age, the failure to adequately address the opioid epidemic continues to negatively impact the next generations. Accurate and timely identification of infants at risk for withdrawal from in-utero exposure is critical to ensure high-quality perinatal and neonatal care. Beginning with an evaluation of current best practices and performing a literature review, we identify the challenges to current screening processes and how these limitations limit the ability to provide appropriate care to infants at the risk of withdrawal. We first describe the limitations of the available assays for the detection of opioid and opioid metabolites across different biological sources from both the mother and the infant. We then present a discussion surrounding factors that contribute to maternal willingness to disclose use. Particularly, in light of the limitations of biological screening, any barrier to maternal disclosure further complicates effective care delivery. Barriers to disclosure include legal ramifications and state policies, provider and societal behaviors and biases, and maternal factors. Moving forward, universal prenatal screening surveys coupled with enhanced outreach and education to providers centering on the limitations of both patient report and biological sampling, as well as comprehensive and supportive services for women of reproductive age with substance use disorders, are needed to both enhance detection for NOWS and improve long-term maternal-child health.
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Affiliation(s)
- Meghan P Howell
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Alyssa M Smith
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Elizabeth B Lindsay
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Stacy S Drury
- Department of Child and Adolescent Psychiatry, Tulane University School of Medicine, New Orleans, LA, USA
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Mc Elhinney H, Taylor BJ, Sinclair M. Decision Making by Health and Social Care Professionals to Protect an Unborn Baby: Systematic Narrative Review. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/13575279.2019.1612733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Helena Mc Elhinney
- Institute of Nursing and Health Research, Maternal Fetal and Infant Research Centre, Ulster University, Belfast, UK
| | - Brian J. Taylor
- School of Applied Social and Policy Sciences, Ulster University, Belfast, UK
| | - Marlene Sinclair
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
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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: 28] [Impact Index Per Article: 5.6] [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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Symon A, Rankin J, Sinclair H, Butcher G, Smith L, Gordon R, Cochrane L. Peri-Conceptual and Mid-Pregnancy Alcohol Consumption: A Comparison between Areas of High and Low Deprivation in Scotland. Birth 2016; 43:320-327. [PMID: 27620000 DOI: 10.1111/birt.12252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol-related mortality and morbidity among women has increased over recent decades, especially in areas of higher deprivation. Pre-pregnancy alcohol use is associated with continued consumption in pregnancy. We assessed whether general population alcohol consumption patterns were reflected among pregnant women in two Scottish areas with different deprivation levels. METHODS Cross-sectional study in two health boards (HB1, lower deprivation levels, n = 274; HB2, higher deprivation levels, n = 236), using face-to-face 7-day Retrospective Diary estimation of peri-conceptual and mid-pregnancy alcohol consumption. RESULTS A greater proportion of women in HB2 (higher deprivation area) sometimes drank peri-conceptually, but women in HB1 (lower deprivation area) were more likely to drink every week (49.6 vs 29.7%; p < 0.001) and to exceed daily limits (6 units) at least once each week (32.1 vs 14.8%; p < 0.001). After pregnancy recognition, consumption levels fell sharply, but women in HB2 were more likely to drink above recommended daily limits (2 units) each week (2.5 vs 0.0%; p < 0.05). However, women in HB1 were more likely to drink frequently. Women with the highest deprivation scores in each area drank on average less than women with the lowest deprivation scores. CONCLUSIONS Heavy episodic and frequent consumption was more common in the lower deprivation area, in contrast with general population data. Eliciting a detailed alcohol history at the antenatal booking visit, and not simply establishing whether the woman is currently drinking, is essential. Inconsistent messages about the effects of alcohol in pregnancy may have contributed to the mixed picture we found concerning peri-conceptual and mid-pregnancy alcohol consumption.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Jean Rankin
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | | | - Lesley Smith
- Department of Psychology, Social Work & Public Health, Oxford Brookes University, Marston, UK
| | - Rhona Gordon
- School of Nursing & Health Sciences, University of Dundee, Dundee, UK
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Symon A, Rankin J, Butcher G, Smith L, Cochrane L. Evaluation of a retrospective diary for peri-conceptual and mid-pregnancy drinking in Scotland: a cross-sectional study. Acta Obstet Gynecol Scand 2016; 96:53-60. [PMID: 27792241 DOI: 10.1111/aogs.13050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/19/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Heavy episodic ("binge") drinking among women in Scotland is commonplace; prepregnancy drinking is associated with continued antenatal drinking. Evidence for effectiveness of standardized antenatal alcohol assessment is lacking. Alcohol-exposed pregnancies may be missed. We assessed peri-conceptual and mid-pregnancy consumption using a week-long retrospective diary and standard alcohol questionnaires, and evaluated the agreement between these instruments. MATERIAL AND METHODS Cross-sectional study in two Scottish health board areas involving 510 women attending mid-pregnancy ultrasound scan clinics. Face-to-face administration of alcohol retrospective diary and AUDIT or AUDIT-C assessed weekly and daily alcohol consumption levels and patterns. Depression-Anxiety-Stress Scale (DASS-21) assessed maternal wellbeing. A sub-sample (n = 30) provided hair for alcohol metabolite analysis. Pearson's correlation coefficient investigated associations between questionnaires and alcohol metabolite data. RESULTS The response rate was 73.8%. The retrospective diary correlated moderately with AUDIT-C and AUDIT but elicited reports of significantly higher peri-conceptual consumption, (median unit consumption on "drinking days" 6.8; range 0.4-63.8). Additional "special occasions" consumption ranged from 1 to 125 units per week. Correlations between DASS-21 and retrospective diary were weak. Biomarker analysis identified three instances of hazardous peri-conceptual drinking. CONCLUSIONS Women reported higher consumption levels when completing the retrospective diary, especially regarding peri-conceptual "binge" drinking. Routine clinical practice methods may not capture potentially harmful or irregular drinking patterns. Given the association between prepregnancy and antenatal drinking, and alcohol's known teratogenic effects, particularly in the first trimester, the retrospective diary may be a useful low-tech tool to gather information on alcohol intake patterns and levels.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Jean Rankin
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | - Lesley Smith
- Department of Social Work and Public Health, Oxford Brookes University, Oxford, UK
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Symon A, Rankin J, Sinclair H, Butcher G, Barclay K, Gordon R, MacDonald M, Smith L. Peri-conceptual and mid-pregnancy drinking: a cross-sectional assessment in two Scottish health board areas using a 7-day Retrospective Diary. J Adv Nurs 2016; 73:375-385. [PMID: 27555470 DOI: 10.1111/jan.13112] [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] [Accepted: 07/13/2016] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to evaluate the use of a 7-day Retrospective Diary to assess peri-conceptual and mid-pregnancy alcohol consumption. BACKGROUND Alcohol consumption among women has increased significantly and is of international concern. Heavy episodic ('binge') drinking is commonplace and is associated with unintended pregnancy. Pre-pregnancy drinking is strongly associated with continued drinking in pregnancy. Routine antenatal assessment of alcohol history and current drinking is variable; potentially harmful peri-conceptual drinking may be missed if a woman reports low or no drinking during pregnancy. DESIGN Cross-sectional study (n = 510) in two Scottish health board areas. METHODS Face-to-face Retrospective Diary administration from February to June 2015 assessing alcohol consumption in peri-conceptual and mid-pregnancy periods. Women were recruited at the mid-pregnancy ultrasound clinic. RESULTS Of 510 women, 470 (92·0%) drank alcohol before their pregnancy; 187 (39·9%) drank every week. Retrospective assessment of peri-conceptual consumption identified heavy episodic drinking (more than six units on one occasion) in 52·2% (n = 266); 19·6% (n = 100) reported drinking more than 14 units per week, mostly at the weekend; 'mixing' of drinks was associated with significantly higher consumption. While consumption tailed off following pregnancy recognition, 5·5% (n = 28) still exceeded the recommended daily two-unit limit in pregnancy. Multivariable logistic regression identified that women who 'binged' peri-conceptually were 3·2 times more likely to do this. CONCLUSION Statistically significant peri-conceptual consumption levels suggest a substantial proportion of alcohol-exposed pregnancies before pregnancy recognition. Not taking a detailed alcohol history, including patterns of consumption, will result in under-detection of alcohol-exposed pregnancies. The Retrospective Diary offers practitioners a detailed way of enquiring about alcohol history for this population.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, UK
| | - Jean Rankin
- Maternal, Child and Family Health, School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | | | - Kylie Barclay
- School of Nursing and Health Sciences, University of Dundee, UK
| | - Rhona Gordon
- School of Nursing and Health Sciences, University of Dundee, UK
| | | | - Lesley Smith
- Department of Psychology, Social Work and Public Health, Oxford Brookes University, Marston, UK
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Fonti S, Davis D, Ferguson S. The attitudes of healthcare professionals towards women using illicit substances in pregnancy: A cross-sectional study. Women Birth 2016; 29:330-5. [DOI: 10.1016/j.wombi.2016.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/15/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
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Rushmer RK, Cheetham M, Cox L, Crosland A, Gray J, Hughes L, Hunter DJ, McCabe K, Seaman P, Tannahill C, Van Der Graaf P. Research utilisation and knowledge mobilisation in the commissioning and joint planning of public health interventions to reduce alcohol-related harms: a qualitative case design using a cocreation approach. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BackgroundConsiderable resources are spent on research to establish what works to improve the nation’s health. If the findings from this research are used, better health outcomes can follow, but we know that these findings are not always used. In public health, evidence of what works may not ‘fit’ everywhere, making it difficult to know what to do locally. Research suggests that evidence use is a social and dynamic process, not a simple application of research findings. It is unclear whether it is easier to get evidence used via a legal contracting process or within unified organisational arrangements with shared responsibilities.ObjectiveTo work in cocreation with research participants to investigate how research is utilised and knowledge mobilised in the commissioning and planning of public health services to reduce alcohol-related harms.Design, setting and participantsTwo in-depth, largely qualitative, cross-comparison case studies were undertaken to compare real-time research utilisation in commissioning across a purchaser–provider split (England) and in joint planning under unified organisational arrangements (Scotland) to reduce alcohol-related harms. Using an overarching realist approach and working in cocreation, case study partners (stakeholders in the process) picked the topic and helped to interpret the findings. In Scotland, the topic picked was licensing; in England, it was reducing maternal alcohol consumption.MethodsSixty-nine interviews, two focus groups, 14 observations of decision-making meetings, two local feedback workshops (n = 23 andn = 15) and one national workshop (n = 10) were undertaken. A questionnaire (n = 73) using a Behaviourally Anchored Rating Scale was issued to test the transferability of the 10 main findings. Given the small numbers, care must be taken in interpreting the findings.FindingsNot all practitioners have the time, skills or interest to work in cocreation, but when there was collaboration, much was learned. Evidence included professional and tacit knowledge, and anecdotes, as well as findings from rigorous research designs. It was difficult to identify evidence in use and decisions were sometimes progressed in informal ways and in places we did not get to see. There are few formal evidence entry points. Evidence (prevalence and trends in public health issues) enters the process and is embedded in strategic documents to set priorities, but local data were collected in both sites to provide actionable messages (sometimes replicating the evidence base).ConclusionsTwo mid-range theories explain the findings. If evidence hassaliency(relates to ‘here and now’ as opposed to ‘there and then’) andimmediacy(short, presented verbally or visually and with emotional appeal) it is more likely to be used in both settings. A second mid-range theory explains how differing tensions pull and compete as feasible and acceptable local solutions are pursued across stakeholders. Answering what works depends on answering for whom and where simultaneously to find workable (if temporary) ‘blends’. Gaining this agreement across stakeholders appeared more difficult across the purchaser–provider split, because opportunities to interact were curtailed; however, more research is needed.FundingThis study was funded by the Health Services and Delivery Research programme of the National Institute for Health Research.
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Affiliation(s)
- Rosemary K Rushmer
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Mandy Cheetham
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Lynda Cox
- Clinical Directorates, NHS England, Newcastle upon Tyne, UK
| | - Ann Crosland
- Department of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, UK
| | - Joanne Gray
- Department of Public Health and Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | | | - David J Hunter
- Centre for Public Policy and Health, School of Medicine, Pharmacy and Health, Wolfsan Research Institute, Durham University, Durham, UK
| | - Karen McCabe
- Department of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, UK
| | - Pete Seaman
- Glasgow Centre for Population Health, Glasgow, UK
| | | | - Peter Van Der Graaf
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
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Jaques SC, Kingsbury A, Henshcke P, Chomchai C, Clews S, Falconer J, Abdel-Latif ME, Feller JM, Oei JL. Cannabis, the pregnant woman and her child: weeding out the myths. J Perinatol 2014; 34:417-24. [PMID: 24457255 DOI: 10.1038/jp.2013.180] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/23/2013] [Accepted: 12/12/2013] [Indexed: 11/09/2022]
Abstract
To review and summarise the literature reporting on cannabis use within western communities with specific reference to patterns of use, the pharmacology of its major psychoactive compounds, including placental and fetal transfer, and the impact of maternal cannabis use on pregnancy, the newborn infant and the developing child. Review of published articles, governmental guidelines and data and book chapters. Although cannabis is one of the most widely used illegal drugs, there is limited data about the prevalence of cannabis use in pregnant women, and it is likely that reported rates of exposure are significantly underestimated. With much of the available literature focusing on the impact of other illicit drugs such as opioids and stimulants, the effects of cannabis use in pregnancy on the developing fetus remain uncertain. Current evidence indicates that cannabis use both during pregnancy and lactation, may adversely affect neurodevelopment, especially during periods of critical brain growth both in the developing fetal brain and during adolescent maturation, with impacts on neuropsychiatric, behavioural and executive functioning. These reported effects may influence future adult productivity and lifetime outcomes. Despite the widespread use of cannabis by young women, there is limited information available about the impact perinatal cannabis use on the developing fetus and child, particularly the effects of cannabis use while breast feeding. Women who are using cannabis while pregnant and breast feeding should be advised of what is known about the potential adverse effects on fetal growth and development and encouraged to either stop using or decrease their use. Long-term follow-up of exposed children is crucial as neurocognitive and behavioural problems may benefit from early intervention aimed to reduce future problems such as delinquency, depression and substance use.
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Affiliation(s)
- S C Jaques
- Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia
| | - A Kingsbury
- Mater Miseriacordiae Health Service Brisbane, Mater Mothers' Hospital, South Brisbane, QLD, Australia
| | - P Henshcke
- Mercy Women's Hospital, Heidelberg, Melbourne, VIC, Australia
| | | | - S Clews
- The Langton Centre, Surry Hills, NSW, Australia
| | - J Falconer
- The Langton Centre, Surry Hills, NSW, Australia
| | - M E Abdel-Latif
- The Centenary Hospital for Women and Children, Canberra, ACT, Australia
| | - J M Feller
- 1] The Sydney Children's Hospital, Randwick, NSW, Australia [2] School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - J L Oei
- 1] Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia [2] School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
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Gould GS, Munn J, Avuri S, Hoff S, Cadet-James Y, McEwen A, Clough AR. “Nobody smokes in the house if there's a new baby in it”: Aboriginal perspectives on tobacco smoking in pregnancy and in the household in regional NSW Australia. Women Birth 2013; 26:246-53. [DOI: 10.1016/j.wombi.2013.08.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/12/2013] [Indexed: 11/28/2022]
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Rollans M, Schmied V, Kemp L, Meade T. Digging over that old ground: an Australian perspective of women's experience of psychosocial assessment and depression screening in pregnancy and following birth. BMC WOMENS HEALTH 2013; 13:18. [PMID: 23570282 PMCID: PMC3636103 DOI: 10.1186/1472-6874-13-18] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 03/15/2013] [Indexed: 11/16/2022]
Abstract
Background There is increasing recognition of the need to identify risk factors for poor mental health in pregnancy and following birth. In New South Wales, Australia, health policy mandates psychosocial assessment and depression screening for all women at the antenatal booking visit and at six to eight weeks after birth. Few studies have explored in-depth women’s experience of assessment and how disclosures of sensitive information are managed by midwives and nurses. This paper describes women’s experience of psychosocial assessment and depression screening examining the meaning they attribute to assessment and how this influences their response. Methods This qualitative ethnographic study included 34 women who were observed antenatally in the clinic with 18 midwives and 20 of the same women who were observed during their interaction with 13 child and family health nurses after birth in the home or the clinic environment. An observational tool, 4D&4R, together with field notes was used to record observations and were analysed descriptively using frequencies. Women also participated in face to face interviews. Field note and interview data was analysed thematically and similarities and differences across different time points were identified. Results Most participants reported that it was acceptable to them to be asked the psychosocial questions however they felt unprepared for the sensitive nature of the questions asked. Women with a history of trauma or loss were distressed by retelling their experiences. Five key themes emerged. Three themes; ’Unexpected: a bit out of the blue’, ‘Intrusive: very personal questions’ and ‘Uncomfortable: digging over that old ground’, describe the impact that assessment had on women. Women also emphasised that the approach taken by the midwife or nurse during assessment influenced their experience and in some cases what they reported. This is reflected in the themes titled: Approach: ’sensitivity and care’ and ’being watched’. Conclusions The findings emphasise the need for health services to better prepare women for this assessment prior to and after birth. It is crucial that health professionals are educationally prepared for this work and receive ongoing training and support in order to always deliver care that is empathetic and sensitive to women who are disclosing personal information.
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Affiliation(s)
- Mellanie Rollans
- School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia.
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Bloom T, Glass N, Curry MA, Hernandez R, Houck G. Maternal stress exposures, reactions, and priorities for stress reduction among low-income, urban women. J Midwifery Womens Health 2012; 58:167-74. [PMID: 23278984 DOI: 10.1111/j.1542-2011.2012.00197.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Maternal psychosocial stress has been associated with adverse maternal-child outcomes. Vulnerable women's experiences with stressors during pregnancy and their desires and priorities for appropriate and useful stress reduction interventions are not well understood. METHODS Qualitative interviews with low-income, urban women explored their stress exposures and reactions during pregnancy, ways that stressors overlapped and interacted, and their priorities for stress reduction. Quantitative measures (Perceived Stress Scale; My Exposure to Violence Instrument Danger Assessment; Center for Epidemiologic Studies of Depression Scale, Revised; and Posttraumatic Stress Disorder Checklist-Civilian) supplemented qualitative descriptions of women's stress exposures and reactions. Analyses explored relationships between stressors and women's priorities for stress intervention. Lay advisors from the sample population reviewed qualitative interview guides for appropriateness, completeness, and language prior to interviews and reviewed study findings for validity. Study findings were returned to the community in newsletter form. RESULTS Twenty-four low-income, urban women participated in interviews. Women in the sample reported high stress, lifetime violence exposure, depression, and posttraumatic stress disorder symptoms. The most common stressors reported were financial strain, violence exposure, and feelings of intense isolation and loneliness. Few participants reported having discussed psychosocial stressors with prenatal care providers. Participants in this study described connections with other women as desirable to relieve their stress and provided input on ways health care providers could facilitate such connections. DISCUSSION Clinical and research implications of findings are discussed, including approaches that health care providers may find useful to facilitate connections among vulnerable pregnant women.
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Affiliation(s)
- Tina Bloom
- Sinclair School of Nursing, Columbia, MO 65211, USA.
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Abstract
Maternity for opiate users in Vietnam is challenging due to the criminalization of drug use, stigmatization, and poor specialist knowledge among health providers. This article outlines action research conducted among Vietnamese women who had experienced pregnancy while opiate-dependent. Misguided fears that their baby would be a “monstrosity” drove some women to seek out abortion. For those who chose to continue with their pregnancy, communication with health professionals was poor and misinformation concerning advised maternal practices and newborn care was common. Often women made intuitive decisions; few attempted to go “cold turkey” and withdrew suddenly from opiates while pregnant, and most new mothers chose to breastfeed—a healthy choice—despite being advised against this. The study revealed the importance of support provided outside of state services and culminated in new information for female drug users and training materials for peer counselors. The participatory process by which these outputs were developed is outlined.
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Affiliation(s)
- Joanna White
- Independent Researcher, Hanoi, Vietnam
- Centre for Research in Anthropology, Instituto Universitário de Lisboa, Portugal
| | - Pauline Oosterhoff
- Medical Committee Netherlands–Vietnam, Hanoi, Vietnam
- Royal Tropical Institute, Amsterdam, Netherlands
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27
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Morris M, Seibold C, Webber R. Drugs and having babies: an exploration of how a specialist clinic meets the needs of chemically dependent pregnant women. Midwifery 2011; 28:163-72. [PMID: 21658823 DOI: 10.1016/j.midw.2011.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 02/08/2011] [Accepted: 03/06/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES to explore the extent to which a specialist clinic meets the needs of chemically dependent women. DESIGN a critical ethnography informed by theorists such as Habermas and feminists' interpretation of Foucault. SETTING a specialist antenatal clinic for chemically dependent pregnant women at a major metropolitan women's hospital in Melbourne, Australia. PARTICIPANTS a purposive sample of twenty (20) chemically dependent pregnant women who attended the clinic. Data collection and analysis included three taped interviews (two preceding the birth and one post birth), observation of the interactions between the women and the clinic staff over a 25-month period and chart audits. FINDINGS similar to other studies there were multiple factors influencing development and maintenance of chemical dependency in this group of women, including family instability, family history of drug and alcohol abuse, childhood sexual abuse, having a chemically dependent partner and having a dual diagnosis of both drug addiction and mental illness. Initially there was considerable variation between the women and the clinic staff's expectations with regard to attending for antenatal care and conforming to a set regime as the women struggled with the contradictions inherent in their lifestyle and that of the 'normal' expectant mother. Aspects of that struggle included their belief that their opinions and knowledge of their lives was largely ignored, leading to episodes of resistance. Several women alleged the clinics staff's relationship with them was influenced by a belief that the women were 'hopeless addicts in need of expert medical and midwifery care' and that the clinic staff exercised control in an authoritarian manner. However, as they explored possibilities for collaboration, they realised they could exercise power and work towards a more equal relationship with staff. The quality of relationships in most instances improved over time, and if not always strictly collaborative, was situated at various points along a continuum from minimal to full co-operation, with concomitant varying levels of success in terms of outcomes. It was often the attitude of individual staff members, particularly midwives, that was the key to the way in which the women responded to care. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE comprehensive history-taking and engaging women as early as possible in pregnancy; providing continuity of care - particularly midwife care - to assist in developing a collaborative approach to care; provision of an extended period of postnatal support to at least six months for those women able to parent their children was a key recommendation.
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Affiliation(s)
- Michelle Morris
- Faculty of Health Sciences, Australian Catholic University, Australia.
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