Mother vs. Child? Healthcare professionals' perceptions of maternal-fetal conflict in antenatal substance use

First published: 10 May 2019 | Last updated: 20 May 2019

Aims: Substance use in pregnancy is a common health issue in the UK. Healthcare workers supporting women using substances in pregnancy are exposed to the contrasting discourses of child-centred policy and woman-centred practice. This study explores the model of the maternal-fetal relationship used by healthcare workers, and their perceptions of maternal-fetal conflict in antenatal substance use.

Methods: Semi-structured interviews were conducted with six healthcare professionals working within a hospital-based clinic on the south coat of the UK. Framework analysis was conducted, applying Marcellus ‘ four models of the maternal-fetal relationship: Woman-Centred, Fetus-Centred, Mother and Fetus as Distinct Individuals and Pregnant Embodiment.

Results: Healthcare workers providing care for women using substances in pregnancy experience conflict from numerous sources, forcing them to continually construct and adjust their model of the maternal-fetal relationship. Participants felt there was tension between their personal ideology of motherhood versus their professional experience and struggled with the distinction between ‘fetus’ and ‘baby.’ Alcohol was perceived as distinct from the other substances used by pregnant women, resulting in abstinence based messaging. In the case of illegal substances, a harm reduction approach was supported.

Conclusions: Healthcare professionals identified the need for ongoing postnatal support for women who have used substances throughout pregnancy. The inclusion of substance use teaching into all antenatal training will reduce stigma. Further research is required to explore the distinct conceptualisation of alcohol in pregnancy among healthcare staff. These recommendations will be disseminated among participants at a staff meeting and medical students undertaking clinical placements within the service.


[Supervisors] Dr Camille Stengel BA(Hons) MA PhD – Research Fellow, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine; Ms Sarah Moxon BNurs DICHC MPH – Research Assistant, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine; Dr Neil Aiton MBBS MD MRCP FRCPCH – Consultant Neonatologist, Trevor Mann Baby Unit, Royal Sussex County Hospital.

Conflicts of interest:

No conflict of interest.

Miss Chloe Knox