Problematic substance use in midwives registered with the United Kingdom's Nursing and Midwifery Council: A pragmatic mixed methods study

Sally Pezaro*, Karen Maher, Elizabeth Bailey, Gemma Pearce

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review


    Objective Use a pragmatic mixed methods approach to provide a rich understanding of the perceptions of Problematic Substance Use (PSU) and the influences of PSU on the mental and physical health of midwives registered with the Nursing and Midwifery Council (NMC). Design A confidential and anonymous self-administered online survey was employed to encourage wider participation. Setting United Kingdom Participants Midwives (n=623) registered with the NMC Measurements Open text responses were invited throughout the survey. Along with the collection of brief demographic data, PSU was also measured using the Tobacco, Alcohol, Prescription Medications, and Substance Use/Misuse (TAPS) Tool whilst mental and physical health was measured via version 2 of the Medical Outcomes Study Short-Form 12-Item Health Survey. All qualitative open text responses were analysed inductively using reflexive thematic analysis. Multiple regression was used to test whether health outcomes in the sample as a whole were predicted by PSU and Mann-Whitney U tests to compare the health dimensions between participants who met the criteria for PSU and those who did not. Findings PSU significantly predicted poorer general health, physical functioning, and mental functioning. Additionally, those who met criteria for PSU experienced significantly poorer general, mental, and physical health than those who did not. The influence of PSU was captured via 3 themes and 10 subthemes. Though the signs and symptoms of PSU identified remained broadly consistent, approaches to management did not. Many midwives were conflicted in how they might seek support without facing professional, personal and practical reprisal. Key conclusions and implications for practice PSU in midwifery populations poses professional, personal, and occupational risks. Congruence between policies and approaches to identification and management may reduce risk overall. Future interventions including educational and practitioner health programmes could also be usefully co-created with midwives, policy, and decision makers to reduce stigmatising attitudes and encourage greater awareness, compassion and help seeking to appropriate sources.
    Original languageEnglish
    Article number103409
    Publication statusPublished (VoR) - 20 Jun 2022


    The team would sincerely like to thank everyone who took part in this research. We would also like to thank the ‘Make Birth Better’ Network, the British Journal of Midwifery and the Royal College of Midwives for supporting our recruitment efforts.

    FundersFunder number
    Royal College of Midwives


      • Midwives
      • Midwifery
      • Substance use
      • Addiction
      • Impairment
      • Occupational health


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