Hot Topic: New research explores midwives’ problematic substance use one year on from the first COVID-19 lockdown

By Sally Pezaro, Karen Maher on 29 June 2021


In health care professionals, substance use becomes problematic when impairment impacts upon performance, relationships, attendance, reliability, and the quality and safety of care given (Fan et al 2016). Such Problematic Substance Use (PSU) is suggested to occur in response to work-related stress and burnout (Monroe et al 2013). This has ramifications for midwifery; from a survey of 1997 midwives from the United Kingdom (UK), 1464 (83 per cent) reported experiencing work-related stress (Hunter et al 2019).

Historically midwifery professionals have been described as being at particular risk of substance use/misuse (Roth 1987). More recently, an examination of 1298 fitness to practise cases put before the Nursing and Midwifery Council (NMC) in the UK between 2014 and 2016 identified 208 cases relating to alcohol (16 per cent) and 131 cases relating to drug misuse (10 per cent) (Searle et al 2017). Unfortunately, the data presented in this study are not categorised into midwifery and nursing populations, and a recent mixed-methods systematic review on PSU has revealed a lack of evidence in relation to midwifery populations in particular (Pezaro et al 2020). Other relevant literature has thus far been dominated by the experiences and care of physicians (Weenink et al 2017). If PSU in midwifery populations is left unaddressed, there remains a risk to the quality and safety of perinatal care as well as a compromise to the health and well-being of midwives.

What is happening within midwifery?

Concerned by the lack of research and innovation in this area, the lead author, a registered midwife and NMC panellist, along with a wider research team based at Coventry University, collected data in relation to PSU, help-seeking and perceptions of impairment from 623 registered midwives from January to March 2020 (Pezaro 2020).

Our findings from this study were broadly in line with those from other professional groups in health care, where PSU has been reported in 6-10 per cent of nursing populations (Ross et al 2018), and in 8-15 per cent of physicians (Vayr et al 2019). Within nursing populations, alcohol use disorder has been measured at 6-10 per cent (Servodidio 2011) and a recent meta-analysis including 457,415 health care workers globally has reported the pooled prevalence of tobacco use at 21 per cent (Nilan et al 2019). Our findings were also in line with those of paramedics, for whom PSU may also be linked to occupational distress (Hichisson & Corkery 2020), indicating that this is an area worthy of further investigation.

Read the full article

Pezaro S, Maher K. MIDIRS Midwifery Digest, June 2021, vol 31, no 2, pp 142-144

Original article © MIDIRS 2021