Models of perinatal care for women using drugs and their infants: synopsis of The Stepping Stones Study

Background

Women who use drugs during the perinatal period often have complex health and social care needs. Their infants can experience developmental and health problems. Despite United Kingdom’s guidelines and policies on the care of pregnant women and mothers who use drugs, there is little evidence of the services that are available in the United Kingdom and whether they meet the needs of women and their infants.

This study sought evidence of (1) best practice models for care that have the potential to interrupt the transmission of adversity across generations and (2) the views and experiences of women and staff on different models of care and how services could be improved. The study involved systematic reviews, longitudinal qualitative research and coproduction. There were three phases.

In phase 1, an Expert Advisory and CoProduction Group was established to guide the research and to develop a theory of change for improved service models. The group comprised multidisciplinary stakeholders from health and social care and peer advisers.

Two reviews were undertaken:

1. A scoping review of UK guidance for perinatal care for women who use drugs included 111 documents, recommending integrated multidisciplinary working.

2. A mixed-methods systematic review of evidence of integrated models of perinatal care for women who use drugs and their babies reviewed 197 studies. Qualitative findings suggest that women appreciate collocated services that are easy to access. Quantitative findings found evidence that integrated programmes at the point of delivery decrease substance use during the perinatal period.

Phase 2 involved a qualitative longitudinal study in four sites, two in England and two in Scotland, that aimed to explore perinatal care pathways. Up to five interviews were conducted with 36 women, from early pregnancy up to 18 months post natal (131 interviews). Many women experienced stigma and were anxious about social services’ involvement. Access to residential treatment and mental health support was uneven. Support for women who had lost care of their babies was poor.

Focus group interviews (79 staff) and individual interviews (21 staff) were conducted with health and social care practitioners. Staff reported that high caseloads, staff turnover and training gaps contributed to difficulties in providing care to this challenging group.

In phase 3, the Expert Advisory and CoProduction Group worked with the research team to develop a theory of change for recommendations for an optimised service model. The theory of change identified eight key recommendations and emphasised that a whole-system approach is required to meet the complex needs of this population.

Limitations

For the quantitative findings of the mixed-methods systematic review, the diversity of study types made it difficult to draw firm conclusions on the effectiveness of different approaches. Not all women recruited to the qualitative longitudinal study took part in all the anticipated interviews.

Future research

There is a need for high-quality research studies into effective interventions for pregnant women who use drugs. Implementation research is required to test and implement the theory of change for optimum services for women who use drugs in the perinatal period.

Funding

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130619.