Substance misusing women and pregnancy. Problematised mothers and the management of spoiled identities

1. Substance misusing women and pregnancy. Problematised mothers and the management of spoiled identities Polly Radcliffe, University of Kent

2. Policy and Guidance ‘If women feel stigmatised or discriminated against by staff because they are drug users, a productive and co-operative relationship is unlikely and the baby may suffer’ (ACMD, 2003, 73) Key role maternity services ‘in engaging women who otherwise never or rarely access health services’ (DoH, 2007)

3. Description of the study ESRC funded study Three hospital trusts Interviews with 24 women Recruited via midwives and drug workers Interviews with midwives, drug workers, doctors Ethically reviewed

4. Motherhood and morality Difficult for a ‘bad’ mother to claim a moral self (May, 2008) Women’s substance use and misuse has historically indeed been more stigmatised than for their male counterparts (Bancroft, 2009; Ettorre, 2004; Finkelstein, 1994)

5. Characteristics of the sample Average age 30 Opiate users Stable on methadone All smokers No problem drinkers Engaged with services Half pregnant, half given birth

6. The Management of Identity Leading a double life I know a lot of people, you know are quite ignorant of things so I wouldn’t [talk about it] for my son’s sake, because I don’t want people saying anything to him (Maureen, Southern Conurbation)

7. In the first few days and stuff I was really jittery about any of them seeing my notes because they come round with a trolley and ask ‘Does anyone want their medication?’ and then they look at your notes and if it’s a new person who doesn’t know, you know, I have to keep saying shhh’ do you know what I mean, every time (Daniella, London)

8. Ignorance In Hospital I found they was all really nice with me. But obviously you get the odd couple that are a little bit..because some them are unsure of what it is, [what it] actually involves and everything, so they obviously think methadone, heroin, drug user, you know what I mean? (Sonia, Southern County)

9. No distinction between chaotic drug users and stable use of methadone ‘Right Emily, we need to test your urine’ I hadn’t been urine tested for weeks and weeks and weeks and then all of a sudden I was there where I’d given birth, so when they thought I’d got the time to go and get some drugs and take them away was beyond me (Emily, London)

10. Institutional Distrust It was just horrible, it was like a big spotlight put on me. They wanted to know, just like nothing’s private and this meeting, my son’s school teacher was there, his headmistress and all my test results from Drug Service were read out in front of all these people and I just, I don’t think that’s right. Why does my son’s teacher need to know my drug test results and what appointments I’ve missed? (Deirdre, Southern County)

11. Conclusions Women with a history of substance misuse strategically present themselves as ‘worthy’ of motherhood Dominant narratives and distrust of ‘junkie mothers’ can be reproduced in maternity settings Services in hospital and the community need to be designed to counter stigma.

12. Acknowledgements Thanks to all the women who shared their experiences with me, the maternity service and drug service staff from the three hospital trusts who gave me access to their patients and clients. Polly Radcliffe University of Kent at Canterbury p.c.radcliffe@kent.ac.uk