In January 2020, we, in partnership with a wider research team from Coventry University, collected data from 623 midwives in relation to their problematic substance use (PSU), help seeking and perceptions of impairment (Pezaro 2020). Our findings were broadly in line with other professional groups in healthcare, in that a lack of support, fear, shame, stigma and denial can act as barriers to help seeking and highlight the need for targeted workplace interventions in this area (Weenink et al, 2017).
In paramedics, PSU may be linked to occupational distress (Hichisson and Corkery, 2020). This was similarly evident from our data with midwives. PSU has been reported in 6%–20% of nursing populations (Ross et al, 2018), and in 8%–15% of physicians (Vayr et al, 2019). In a nursing population, the criteria for alcohol use disorder was met in 6%–10% of those surveyed (Servodidio, 2011), and a recent meta-analysis representing 457 415 healthcare workers globally has identified the pooled prevalence of tobacco use at 21% (Nilan et al, 2019).
In a UK context, a recent study examining 1 298 fitness-to-practise cases put before the Nursing and Midwifery Council (NMC) in the UK between 2014–2016 identified 208 cases relating to alcohol (16%) and 131 cases relating to drug misuse (10%) (Searle et al, 2017). Yet, relevant literature has thus far been dominated by the experiences and care of physicians (Weenink et al, 2017), with a recent mixed-methods systematic review identifying a particular lack of evidence in relation to PSU in midwifery populations (Pezaro et al, 2020).
While our mixed-method study conducted early in 2020 was the first to explore PSU, help seeking and perceptions of impairment among UK-based midwives, data collection was ended prematurely in response to the COVID-19 lockdown to avoid a distortion of results. While methodologically necessary, this was disappointing as a larger sample would have enabled more voices to be heard and may have generated richer understandings to inform how we might now reduce risk and support professionals both in recovery and prevention.
‘A lack of support, fear, shame, stigma and denial can act as barriers to help seeking’
Historically, midwives have been reported as being at particular risk of substance use/misuse (Roth, 1987). Yet, there is no definition of ‘impairment’ provided by the NMC's legislative framework, and there are some subtle and complex philosophical differences in how it is conceptualised. Substance use becomes problematic in healthcare professionals when ‘impairment’ impacts upon performance, relationships, attendance, reliability, and the quality and safety of care given (Fan et al, 2016). Moreover, PSU can occur in response to work-related stress and burnout (Monroe et al, 2013) which is a key issue in midwifery; in a survey of 1 997 UK midwives, 1 464 (83%) reported experiencing work-related stress (Hunter et al, 2019). This is concerning as PSU in midwifery populations risks the quality and safety of perinatal care. It also compromises the health and wellbeing of professionals.
One year on from the first COVID-19 lockdown, cases of PSU in healthcare professionals may have been exacerbated (McKay and Asmundson, 2020). Their psychological wellbeing has also depleted (Kinman et al, 2020) and thus their engagement with work may too have diminished (Geraghty et al, 2019). As such, we are now seeking to recruit registered UK midwives to once again participate in a second survey during 2021, to explore whether and how PSU in midwives has changed when compared to those surveyed in 2020. This 2021 survey invites responses in relation to PSU, health, help seeking, engagement at work and intentions to leave the midwifery profession in the current context.
This new study has been given ethical approval by Coventry University's ethics department and is being conducted by Dr Sally Pezaro, a registered midwife, NMC panellist and fellow of the Royal College of Midwives in partnership with Dr Karen Maher, a chartered psychologist. Both of these researchers, based at Coventry University, invite you as UK-registered midwives to complete and share the survey online. All midwives are invited to participate, regardless of whether they engaged with the original survey or not, as we are interested in experiences at the present time.
Your responses, along with the responses of others, will help us to better understand PSU, leaving intentions, help-seeking behaviours, health risks and work engagement in UK midwifery populations.