Antenatal Care of Women Who Use Opioids: A Qualitative Study of Practitioners’ Experiences and Perceptions of Current Service Provision in Scotland, 2021-2022

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This project aimed to described different models of antenatal care in Health Boards covering three of the largest urban areas in Scotland and to explore multi-disciplinary practitioners’ perceptions of the strengths and challenges of working with women who use opioids through these specialist services. The collection comprises 12 transcripts of a range of professionals working with women who use opioids in pregnancy across three health boards in Scotland.

Why do we need this study? Internationally, the rising use of opioid drugs has been described as a crisis. In Scotland, around 500 children a year are born to women who use opioid drugs, for example, heroin and methadone. The little we do know about these children is that they are likely to have poorer health in the first few years of life. We also know that they are more likely to be disadvantaged in other ways, e.g. living in poverty and in unstable housing. The research which has been conducted tends to have collected data on small numbers of children for a limited period of time. This is because these families often have pretty chaotic lives, and may move around a lot, making it difficult for researchers to keep in contact and return to interview them over time. This has led to a lack of information about what happens to these children in the longer term, and where they might need additional support. We also don't know much about the impact of differences in how these children are treated when they are born, and what makes some of these children have better health and development than others. What will the study involve? This study has three stages to it. Firstly we will speak to a range of people who work with women who use drugs about the way that they record data on these families, e.g. midwives, health visitors, nurses, doctors and social workers. We want to find out from them why they record data in certain ways, whether any data is missing or incomplete, and how reliable data are. This information will be used to inform the main study, which will use data recorded in hospital records, birth records, and school records, for example. In Scotland, everyone has a unique health ID number, which allows their data to be linked together. The second stage of the study will bring together data from health, education and social work, to allow us to compare what happens to different groups of children. These groups will contain children who had a mother who used opioids such as methadone in pregnancy because they are addicted to illegal drugs, such as heroin, as well as a group of children whose mother used opioids in pregnancy as chronic pain relief, and children who are similarly disadvantaged, for example living in poverty, but did not have a mother who used opioids in pregnancy. At this stage, we will look at different measures of health, e.g. whether children are obese/overweight, have been admitted to hospital for accidents and injuries, or have conditions such as asthma. We will try to work out the differences in these outcomes between the different groups of children, and what other risks (such as being born very early, or having a mother who smoked during pregnancy) are associated with these outcomes. The third stage of this study will look at the social work data on children born to mothers who used opioids in pregnancy. Many of these children will spend time living away from home, either with other family members or with foster carers. We will look at patterns of movement between different carers and what factors make a child more at risk of having different patterns of care away from home. We will then look at whether being cared for away from home leads to different health and developmental outcomes, compared with children who did not live away from home. Who will benefit? Our study findings will help a range of people and agencies in different ways. It will benefit women who use drugs and their children because it will help to show how practices and policies might better meet their needs. It will benefit society more widely as it will provide a better understanding of the everyday lives of parents and their families. It will also benefit professionals, services and policymakers by offering new understandings about what these families need to support them to give their children the best start in life. It will also advise on how we could collect better data on these families to improve services.