Midwives' descriptions of the postnatal experiences of women who use illicit substances: a descriptive study.

摘要

OBJECTIVES: to describe midwives' perceptions of the early mothering experiences of 20 Australian illicit-drug-using mothers. DESIGN: a qualitative retrospective study using an explorative descriptive design. Twenty client records, completed by research midwives over 6 months (with follow-up visits at 12 and 18 months), formed the data set. Thematic analysis and the techniques associated with constant comparison were used to analyse the data. SETTING: Perth, Western Australia. PARTICIPANTS: twenty postpartum women with a history of using illicit drugs. FINDINGS: seven major themes were identified that described how childbearing women with drug problems strive to be 'normal mums' although living on the fringe of society. The first three major themes were labelled; Baby as the priority; Hating the body: and Life sucks. Theme four represents the level of family and community support available, which had the potential to facilitate and/or hinder the experience. The analysis suggested that women who had good support, particularly at 4 months postpartum and beyond, were more likely to move towards the fifth theme Hanging in there: striving to be a normal mum. Women with minimal support, living in hostile and often abusive environments, gravitated towards the theme of Beyond caring with the eventual consequence being chaos and a return to heavy drug use, labelled Emotional fibrillation. CONCLUSION: very few women were using drugs early in the postnatal period. These new mothers made every effort to prioritise the needs of their newborns, often within a context of abusive relationships, poor emotional well-being and financial hardship. High levels of physical and psychological morbidity were related to psychosocial factors as opposed to drug use alone. By 4 months postpartum, there was evidence that women were becoming increasingly vulnerable to the challenges of their lives. Family and community support played a role in how this group of women moved through their mothering experience. IMPLICATIONS FOR PRACTICE: the range of health, social and support services required by new mothers when they are using illicit drugs is substantial. Collaboration and coordination between agencies is crucial for quality outcomes. Fostering positive relationships with drug-using pregnant women and maintaining these links into the extended postnatal period may be one strategy that would improve the integration of services and ensure that women stay engaged with the system.