Contextual Influences Experienced by Queensland Midwives: A Qualitative Study Focusing on Alcohol and Other Substance Use During Pregnancy

PURPOSE: To understand the experiences and contextual factors that influence the ability of midwives to provide appropriate support to women regarding alcohol and other drug (AOD)e use during pregnancy, in the Queensland context. DESIGN: Using a qualitative approach underpinned by critical realism, we explored the experiences of eleven midwives using semi-structured interviews. Thematic analysis was utilized, which was inductive and deductive, as it aimed to explicate different contextual factors at play, based on the experiences of the current sample of midwives. MAJOR FINDINGS: Experiences of midwives in the current study were influenced by five overarching contextual factors: (a) patient-level factors (complexities experienced by women and lack of knowledge regarding maternity care options); (b) provider/patient-level factors (importance of midwives building relationships with women and importance of continuity of care); (c) provider-level factors (importance of taking a supportive approach, midwife confidence, engagement in AOD screening, variable attitudes and knowledge); (d) organizational-level factors (lack of support and training, concerns regarding communication, time constraints and organizations that limited midwife involvement); (e) broader system-level factors (lack of effective services and inconsistent messages regarding AOD use during pregnancy). CONCLUSIONS: The current study has highlighted a range of practice areas and potential implementation strategies across a number of contextual levels that could be beneficial in the Queensland context to improve maternity care provision for women who are experiencing AOD use challenges during pregnancy.