An exploration of student midwives’ attitudes toward substance misusing women following a specialist education programme

Substance misuse is a complex issue, fraught with many challenges for those affected. Whilst the literature suggests that pregnancy may be a ‘window of opportunity’ for substance misusing women, it also suggests that there are several barriers to women engaging with health care. One of these is the fear of being judged and stigmatised by healthcare professionals, including midwives. Previous research indicates that midwives have negative regard toward substance users and that this in turn may lead to stigmatising behaviours and consequential substandard care provision. Midwives however, stress that they do not have appropriate training to be able to effectively provide appropriate care for substance misusers. Research suggests that education (formal training) is needed in this area to improve attitudes. In this study, the role of education in changing attitude toward substance use in pregnancy was explored using case study methodology. The case was a single delivery of a university degree programme distance learning module ‘Substance Misusing Parents,’ undertaken by 48 final year student midwives across 8 NHS Trusts. The research was carried out in 3 phases, using a mixture of Likert style questionnaires (Jefferson Scale of Physician Empathy and Medical Condition Regard Scale), Virtual Learning Environment discussion board qualitative data and semi structured interviews. The findings of the questionnaires showed that whilst general empathy levels showed no significant change (p=0.539), empathy toward pregnant drug using women showed a statistically significant improvement following the module (p=0.012). Furthermore, exploration of the students’ experiences of the module demonstrated the importance of sharing and reflecting on practice with peers; the experiences of drug users, both positive and negative; and having an opportunity to make sense of these experiences, thus bridging the ‘theory-practice divide,’ as key in influencing their views. Furthermore the findings indicated value in the mode of delivery of such education, suggesting e-learning to be an effective approach, offering not only knowledge gain in terms of the content, but in wider research and critical thinking skills. This research demonstrates the potential of education in this area but also offers suggestions for effective methods of educational delivery to potentially help reduce stigma in other areas of practice.