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Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, IrelandINFANT Centre, University College Cork, Cork, Ireland
Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, IrelandINFANT Centre, University College Cork, Cork, Ireland
Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, IrelandINFANT Centre, University College Cork, Cork, Ireland
Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. Cork University Maternity Hospital, Cork, IrelandNational Perinatal Epidemiology Centre (NPEC), University College Cork. Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork
Previous studies have associated substance use (alcohol, illicit drugs and smoking) to negative pregnancy outcomes, including higher risk of stillbirth.
Aim
This study aims to identify facilitators and barriers reported by women to remain substance free during pregnancy.
Methods
A systematic search was conducted in six databases from inception to March 2019 and updated in November 2020. Qualitative studies involving pregnant or post-partum women, from high-income countries, examining women’s experiences of substance use during pregnancy were eligible. Meta-ethnography was used to facilitate this meta-synthesis.
Findings
Twenty-two studies were included for analysis. Internal barriers included the perceived emotional and social benefits of using substances such as stress coping, and the associated feelings of shame and guilt. Finding insensitive professionals, the lack of information and discussion about risks, and lack of social support were identified as external barriers. Furthermore, the social stigma and fear of prosecution associated with substance use led some women to conceal their use. Facilitators included awareness of the health risks of substance use, having intrinsic incentives and finding support in family, friends and professionals.
Discussion
Perceived benefits, knowledge, experiences in health care settings, and social factors all play important roles in women’s behaviours. These factors can co-occur and must be considered together to be able to understand the complexity of prenatal substance use.
Conclusion
Increased clinical and community awareness of the modifiable risk factors associated with substance use during pregnancy presented in this study, is necessary to inform future prevention efforts.
Substance use during pregnancy is a major contributor to adverse pregnancy outcomes, including stillbirth.
What is already known
Although there is evidence of the risk of smoking, drinking and using illicit substances during pregnancy, there are some women who continue to engage in these behaviours during pregnancy.
What this paper adds
Stillbirth prevention strategies in high income countries should focus on modifiable risk factors. This paper providers further evidence to improve understanding of the complexities and factors affecting the use of substances during pregnancy.
1. Introduction
Prenatal smoking, consumption of alcohol and illicit drug use are significant public health concerns with important implications for women and infants [
]. Smoking, consuming alcohol and using illicit drugs during pregnancy are well established risk factors for a wide range of adverse pregnancy outcomes [
The occurrence of stillbirth differs across countries. In 2008, 2.65 million stillbirths were estimated worldwide, with 98% of them occurring in low-income and middle-income countries [
]. In 2015, the rates of stillbirth per 1000 births at 28 weeks gestation or more in high-income countries varied from 1.3 in Iceland to 8.8 in Ukraine [
]. However, it is difficult to compare rates of stillbirth amongst countries due to the variability in the definitions used and the under-reporting of stillbirths under 28 weeks gestation.
In a systematic review and meta-analysis of 142 studies published in 2015, any active smoking and second-hand smoke exposure during pregnancy were associated with a higher risk of stillbirth (Standardised Rate Ratio (sRR) 1.46 and sRR 1.40 respectively) [
]. Aliyu et al. concluded in their retrospective cohort study with more than 650,000 pregnancies, that the likelihood of stillbirth between 20 and 28 weeks gestations was higher in women who drank alcohol [
]. According to this study, women consuming five or more drinks per week during pregnancy experienced a 70% increase in the risk of stillbirth. Women consuming 1–2 drinks per week had a hazard ratio of 1.5 (95% confidence interval 1.0–2.1), no increase in risk amongst women drinking 3–4 drinks per week, and a peak increase in women drinking 5 or more drinks per week. In terms of illicit drug consumption, Varner et al. concluded that a positive test for any illicit drug in the umbilical cord homogenate was associated with an increase in the risk of stillbirth at 20 weeks gestation (OR 1.94) [
]. This study concluded that the highest prevalence of smoking during pregnancy was in the European Region (8.1%) and the lowest in the African Region (0.8%) [
]. The five countries with the highest estimated prevalence of smoking during pregnancy, regardless of frequency or quantity, were Ireland (38.4%), Uruguay (29.7%), Bulgaria (29.4%), Spain (26.0%) and Denmark (25.2%) [
]. Prevalence of prenatal alcohol consumption has been found to be higher than that of smoking. A systematic review and meta-analysis published by Popova et al. concluded that, globally, 9.8% of women consumed alcohol during their pregnancy [
Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis.
]. The highest prevalence was observed in the European World Health Organization Region (25.2%), whereas the lowest was in the Eastern Mediterranean WHO Region (0.2%). The five countries with the highest estimated prevalence of alcohol use during pregnancy were Ireland (60.4%), Belarus (46.6%), Denmark (45.8%), United Kingdom (41.3%) and Russia (36.5%).
Cocaine, amphetamines, opioids, marijuana, hallucinogens and toluene-based solvents are the illicit drugs that have been found to be most commonly used by pregnant women [
], however, establishing the prevalence of illicit drug use in pregnant women may be more difficult than for alcohol and smoking. For example although social stigma can exist for all of these behaviours during pregnancy, legal repercussions associated with substance use might drive some women to avoid disclosure [
]. However, in the 2010 National Survey on Drugs and Health conducted among pregnant women aged 15 and 44 in the USA, it was reported that 4% of pregnant women were current illicit drug users [
Substance Abuse and Mental Health Service Administration. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Rockville, 2011 DOI:NSDUH Series H-41, HHS Publication No. (SMA) 11-4658.
Understanding women’s attitudes, perceptions and experiences of substance use is essential to obtaining insight into the facilitators and barriers that modulate these behaviours during pregnancy. Qualitative research is a useful approach in this regard to explore and understand the nature and interaction of the different layers of the studied phenomenon while maintaining the particular complexities of human behaviour [
]. To date a number of primary qualitative studies have been conducted to understand women’s prenatal smoking, alcohol and illicit substance consumption [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
Health professionals’ perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and during the post-partum period: a systematic review of qualitative research.
]. However, no prior meta-synthesis has been conducted related to the other types of substances used during pregnancy.
The aim of this meta-synthesis is to analyse and synthesise all of the evidence drawn from qualitative research to date in order to identify facilitators and barriers to a substance-free pregnancy in high income countries. This will facilitate developing in-depth insights and understandings of these prenatal health behaviours [
]. By identifying barriers and facilitators common to different type of substances, we intend to inform the development of a behaviour change intervention applicable in high-income countries.
The synthesis of qualitative research was informed by meta-ethnography. Meta-ethnography is a methodology originally developed by Noblit and Hare with an interpretative approach [
]. In order to do this, the researcher translates the studies into one another’s terms, and into their own interpretation of the data and the world, which will result in a synthesis that is partially produced by the author [
A comprehensive systematic search of the literature was performed for all qualitative research that explored women’s facilitators and barriers to abstain from substance use during pregnancy. The databases searched were CINHAL, PsychINFO, Pubmed, SOCindex and Web of Science and the searchers were conducted on the 28th and 29th of March 2019 with no restrictions on publication date. The search was updated on the 25th of November 2020 to identify new published articles relevant for our synthesis. Further, the reference list of each included study was hand-searched for additional studies.
The protocol for this meta-synthesis was registered on Prospero (no. CRD42019120069). Originally this meta-synthesis had the objective to provide insights into different modifiable risk factors for stillbirth. However, due to the high volume and complexity of the qualitative research on antenatal behaviour practices, this meta-synthesis differs from the original protocol in that it focuses specifically on substance use during pregnancy rather than substance use, attendance at antenatal care and weight management as previously planned. Findings in relation to the other two modifiable risk factors will be published elsewhere.
Search terms were selected based on a preliminary scan of the relevant literature. The search terms used were facilitators, barriers, promoter, benefit, attitude, opportunity, determinant, promotion, intention, education, initiative, prevention, pregnancy, smoking, smoking cessation, nicotine, alcohol, alcohol abuse, alcohol drinking, drug*, drug abuse, illicit drugs, oral drugs, intravenous drugs (see example of search in Supplementary file 1).
2.2 Study selection
Three members of the research team (SM, LL, TES) independently reviewed the titles and abstracts of the studies resulting from the database search. Additionally, two authors independently (SM, TES) conducted the full text screening of the eligible studies.
Studies were included for further review if (1) they used a qualitative or mixed methods design, as long as they included primary qualitative data, (2) they were written in English, (3) the participants were women interviewed when pregnant or up to 12 months post-partum as long as the data referred to their experiences during their pregnancy, (4) they were conducted in high income countries, and (5) included extractable data about facilitators and barriers to remain abstinent from substance abuse during pregnancy.
Studies were excluded if they did not include any qualitative data or if they were not original research. Studies that included different types of participants (e.g.: healthcare professionals and pregnant women, partners and pregnant women) were only included if the data extracted from the pregnant women was differentiated from the rest. In this meta-synthesis, we included studies that explored the views of women who were current substance users during their pregnancies and women who made the choice to remain abstinent during their pregnancy.
2.3 Data extraction
2.3.1 Study characteristics
A data extraction sheet was used to extract the characteristics of the studies by one author (TES). The following data were extracted from each study: country of publication, year of publication, aims, design, data collection method, sampling or recruitment strategy, consent process, number of participants, age of participants, pregnancy status, timing of data collection and method of data analysis.
2.3.2 Quality assessment
The Critical Appraisal Skills Program (CASP) for qualitative studies was used independently by two authors (TES, SM) to assess the quality of the studies. Previous research in the area of quality appraisal has concluded that there is a correlation between the quality of reporting of a study and its value as a source for the final synthesis, and therefore it is appropriate to exclude inadequately reported studies [
]. As a result, it was decided that only the studies with the highest quality (CASP ≥ 15) would be part of the synthesis.
To assess our individual review findings, we used the GRADE-CERQual approach. This approach facilitates assessment of how much confidence can be places on individual review findings from a synthesis of qualitative research [
] proposed a series of phases that overlap and repeat along with the conduction of the synthesis (see Supplementary Table 2).
Phase 1 and 2 – Selecting meta-ethnography and deciding what is relevant
The first two phases of meta-ethnography involve identifying a research gap which has the potential to be filled by meta-ethnography, explaining the rational for using meta-ethnography and stating its purpose and focus, which we have done in the sections above. Phase 2 was completed by conducting a systematic search of the databases as outlined above, and importing the resulting studies into NVivo12 for analysis (see Fig. 1).
Fig. 1PRISMA flow diagram showing the process of inclusion of studies. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097.
During Phase 3, the papers were read in depth several times and the characteristics and details of the papers were extracted and tabulated into the data extraction sheet (Supplementary Table 3). In this phase, each paper was read carefully and notes were used to identify the data that had to be extracted.
Phase 4 – Determining how the studies are related
Phase 4 involved the line-by-line coding of each selected study by one author (TES) using Nvivo12 in order to identify common metaphors and concepts, consulting with the rest of the team when in doubt. We refined the codes in our list and created new ones as the coding progressed in each new study. Every sentence of the studies had to be coded at least once. A second author (SM) coded a sample of the papers to facilitate reliability and validity in the coding process. Both first and second order constructs were extracted for analysis. We utilised second-order constructs to complement the primary data, which offered additional insights, context and explanations. Most of the studies had poor reflexive accounts, which hindered our assessment of the author’s background influence over their interpretations. The key concepts explored and compared in the analysis were related to factors that either facilitated or hindered access to antenatal care for pregnant women in high-income countries.
Once the initial coding was completed, we examined the text added to each code for consistency of interpretation and additional coding was performed when necessary. We obtained a list of concepts that were grouped into themes and categories using thematic analysis.
We used tables to display the concepts and themes across all studies, classifying them depending on the substance they were exploring, this helped us see which concepts and themes juxtaposed across the different studies and substances explored (see Supplementary Tables 4a and 4b). Classifying the studies based on the concepts and themes and grouping them by substance helped us understand how the studies were related and in which aspects they were different. Then concept maps were used to establish and discuss the influences of each concept over the other. After this phase, it was understood that most studies related reciprocally, except those that explore different aspects of the topic.
Phase 5 – Translating studies into one another
Phase 5 involved translating the studies into one another. In this phase, the themes and concepts were further refined to ensure that the themes reflected the meaning of each individual study. The initial codes and themes were examined and combined thematically when describing similar findings.
The influence of each study over each concept obtained is documented using references and quotes. Quotes were obtained from primary study participants and by primary author’s explanations and interpretations. Since the context of the studies were very similar, the studies were organised in sub-groups depending on the substance they were exploring (either alcohol, smoking or illicit drug use, which included Cannabis). In our study, similar contexts are beneficial as they allow us to identify specific facilitators and barriers. This would then better inform the development of a context-specific intervention.
In this article we are presenting first, second and third level interpretations, based on the women’s experiences.
Phase 6 – Synthesizing translations
The result of the translated concepts, their relationships and the primary data were used to create a textual line of argument, which is presented here. Three authors were involved in the synthesis (TES, KMS, SM) and the additional authors provided feedback and insights when necessary (KOD, MB, LL). The authors are from different disciplinary backgrounds including psychology, sociology, medicine, public health, epidemiology and behavioural science, which promoted discussion of potential different interpretations.
Phase 7 – Expressing the synthesis
The findings of this meta-ethnography are presented in this article, additionally, a summarised version of the findings can be found in our CerQual assessment and summary tables (see Supplementary Tables 6 and Table 4a and 4b).
3. Results
3.1 Search outcome
Fig. 1 shows the process of inclusion of studies. The first database search was conducted in March 2019, and identified 25,508 studies. Of these, 18,159 remained after duplicate removal. After screening for titles and abstracts, 85 studies remained potentially eligible for full text review. Following full text screening of the remaining 85 studies, 18 studies met criteria for inclusion in the meta-synthesis. Twelve more studies were examined for potential inclusion after hand-searching the reference list of the included studies, and 2 additional studies were included. The search conducted in November 2020 identified 152 potential studies. Four studies remained potentially eligible after screening for title and abstract, of those, two studies were included in our synthesis. The final number of studies included for synthesis was 22.
Several facilitators and barriers were identified during our analysis that have an influence on womens’ prenatal health behaviours. We classified these factors as internal factors or external factors, with internal factors being those that the woman might have some degree of control over and relate to her own beliefs, knowledge and intrinsic motivation to decide whether to use or not substances during their pregnancy. External factors are those which will have an influence on the woman’s behaviour but are elements over which women have very limited control and relate mostly to their social environment or the healthcare system.
3.2 Study characteristics
The characteristics of the studies included are shown in Supplementary Table 3. Of the 22 studies included for analysis, 14 focused on smoking, 1 on alcohol, 3 on illicit drugs and 4 on different multiple substances. Six were conducted in the UK, 3 in the USA, 3 in Australia, 1 in Canada, 1 in Sweden, 1 in Finland and 1 in New Zealand. The years of publication ranged from 1998 to 2020.
Twenty-one of the studies were qualitative and one mixed-methods. The studies used different data collection methods; nineteen used semi-structured interviews, three used focus groups. The number of participants in the studies ranged from 6 to 53, with ages ranging from 15 to 49 years. Thirteen of the studies included pregnant women only, one included only postpartum women up to 12 months after birth and eight included both pregnant and postpartum women. Regarding the quality appraisals, most of studies performed poorly with regards to reflexibility and ethical considerations, and performed particularly well in the reporting of their aims, qualitative methodology, recruitment strategy and data collection methods justification (See Supplementary Table 5). Results from the GRADE-CERQual analysis are presented in Supplementary Table 6.
4. Synthesis
4.1 Internal factors
Theme 1: Perceived incentives
In this theme we identified internal factors reported by women that might increase or decrease their levels of motivation to use substances or remain abstinent. Women reported perceived psychological and social benefits from their substance use, and additionally, women expressed reasons why interrupting/ceasing their use would have negative consequences upon them. However, some other women were also able to identify benefits of abstaining from substance use.
Category 1.1: Perceived benefits obtained from substance use
Women reported several reasons for continuing to use substances during pregnancy. Lack of motivation to quit [
Furthermore, women reported obtaining benefits from the use of the substances that act as barrier to remain substance free. The most commonly reported benefit of substance abuse was that “It makes me happy; it relaxes me” [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
]. In these cases, despite the fact that women might acknowledge the risks of the substance use, the benefits obtained outweighed the risks.“Smoking and drinking were an important part of her social life, and although she always imagined she would quit when she became pregnant, she found she was unable to do so” [
]“I felt like it was consistently helping me calm down and be able to function enough – well enough to parent my sixyear-old as a single parent and, um, deal with that” [
]. In one of the studies conducted in an American state where Cannabis use was legalised, women from different socioeconomic backgrounds used Cannabis to control their nausea, increase their appetite and manage stress as a “more natural alternative than prescribed medications” [
].“It helps me feel hungry and it takes away my nausea completely. And it helps with the pain, too. And not so much that it takes away all of my pain, but it helps me mentally manage by pain better.” [
In addition, some perceived disadvantages of remaining abstinent were identified, including fear of harming the baby due to the consequences of the abstinence [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (capability, opportunity, motivation-behaviour) model.
Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (capability, opportunity, motivation-behaviour) model.
], since using is a common habit within their partner and/or wider social circle, whereby reported that they “feel left out of some situations with my friends” [
]“There was a couple of times I just tried stopping, just getting sick. I would get a day into the sickness and it would just get to the point where it’s just… I’m running out the door [to get more drugs.]” [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
]. Furthermore, some women spoke about developing an increased perception of willpower and self-efficacy as consequence of their achievements during their process towards abstinence [
For some women, being pregnant or having other children was already motivation enough to attempt quitting, engage in harm reducing actions or to abstain from drugs completely [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
] [Smoking]“The only reason why I quit was because I was pregnant, so I mean, if I hadn’t fallen pregnant, I’d probably still be smoking cigarettes now”
Another factor associated with the pregnancy that acted as a facilitator was the pregnancy-related sickness, women found that smoking or drinking alcohol during their pregnancy made them feel sick resulting in women decreasing their substance use [
Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (capability, opportunity, motivation-behaviour) model.
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
]. These negative feelings in combination with the external pressure from their social environment acted as barriers to abstaining from substance use for some women whereby “you feel even worse and in the end it becomes too much” [
].I just can’t stand it. Sometimes I’ll even try to turn the guilt off, and it’s like it’s still in my head and, you know, what I’m doing and I don’t know why, it’s just so hard for me to quit. Oh, and the baby will kick when I’m smoking, it almost makes me like cry because it’s just like, I shouldn’t. [
Category 3.1: Knowledge about the risks of substance use
Many women discussed a lack of accurate knowledge about the risks women were taking when using substances during pregnancy. One factor that contributes to the generalised lack of accurate knowledge is the use of anecdotal evidence as a source of information and justification for substance use. Regardless of the substance, women often discussed their previous pregnancies or people they knew or heard of that had used substances during their pregnancy who had a healthy baby [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
]. Generalising these individual cases might be contributing to the creation of misconceptions about the risks. Furthermore, using these counter examples as justification might also be used as a coping mechanism to reduce the guilt associated with their substance abuse.“I drank a little bit with my first child and I carried on doing that with my second and third pregnancies. My first child is absolutely fine.” [
] [Alcohol]“So far from what I’ve seen, any girl that I know that’s done dope throughout their pregnancy, their kids are really overachievers. Which, I’m not trying to say, ‘use meth, it’ll make your kids smart.’ I’m just saying that the ones that I do know, there’s nothing wrong with their kids.” [
Women reported misconceptions about the risks of substance use, which were likely a consequence of using unreliable sources to obtain information in combination with the anecdotal evidence explained above. For instance, only heavy use was perceived as dangerous by many women [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (capability, opportunity, motivation-behaviour) model.
]. The distinction between heavy and light use was made by the women in a subjective way, and in many cases, it was not based on medical evidence. For example, light alcohol use was defined by women as “one sip of wine” [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
]. These misconceptions can act as barriers as women rationalise their substance use and decrease the feelings of guilt that women report feeling.“I don’t want that to sound nasty, but like having a small baby, the baby will grow, he can put on weight. . . and doctors are amazing now like. . . there’s more chance of the baby developing a cleft lip as well, that could be fixed with surgery.” [Smoking] [
]. In these cases, despite having some knowledge or awareness of the risks, women share the belief that this cannot happen to them, that “it only happens to other people”.
On the other hand, having more accurate knowledge about the risks of substance use acted as a facilitator to prevent substance use during pregnancy [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
]. In the case of alcohol, for instance, since the information about its risks can be contradictive and confusing, women tended to “go for the safety aspect, so because I'm not 100% sure, I just completely abstain to be on the safe side. [Alcohol]” [
] also acted as facilitators.“It gets not only into your lungs, but it gets into your bloodstream and everything, so why wouldn’t it get into your milk and go to the baby?” [
Despite the fact that many women resort to counter examples and misinformation about the risks to rationalise their use and reduce their feelings of guilt, most of them are aware that there are certain risks associated to their behaviour [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (capability, opportunity, motivation-behaviour) model.
]. In some instances, these changes were in line with common recommendations, whereas with others they were in response to their own perception of what was best for the baby.
The most commonly reported strategy to reduce harm was trying to abstain or cutting down the substance use [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
] was perceived as a positive solution to balance the baby’s needs with their own needs, and it was advised by healthcare professionals when unable to abstain completely [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
]. Although not always adaptive, these behaviours show that women have some motivation to change their habits and therefore considered them facilitators.“We posted a big sign on the front door saying, ‘No Drugs.’” [
],“I was just like, well, ok, in the morning I can just drink coffee instead [of using methamphetamine].’’ When this didn’t work, she tried switching to drinking alcohol, “I will just replace that [methamphetamine] with X amount, with alcohol” [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (capability, opportunity, motivation-behaviour) model.
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
Another reported issue that acts as barrier is the poor communication between healthcare professionals and women about substance use. Women reported only being asked about their substance use at their booking visit “there was no other conversation about it” [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
].“My doctor just tells me that it’s really important for me to quit. Well, I know that already, and I want to quit too. If it were so easy, I would have done it already. So when he says that to me, I just say, “Okay,” and that’s the end of the conversation” [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (capability, opportunity, motivation-behaviour) model.
].“So like my GP I didn’t really get a definitive answer…Whereas when I went to my midwife, for my antenatal appointment that was clearly communicated from day one…” [
“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy Fiona.
].“My doctor, he doesn’t like that I use marijuana at all. […] And once I was pregnant, he’s like, ‘You’ve got to stop.’ And I did stop when we talked about it. But then when I told him my OB’s decision to let me linger a bit, at least until I’m like 20 weeks or so to see if the morning sickness goes away […] He doesn’t like it, but my OB doctor totally understands.” [
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