Development of the Maternal-fetal Relationship in Women Who Use Substances: Understanding the Influence of Intersecting Variables on Maternal-fetal Attachment and Health Behaviours

Abstract

Healthy maternal–infant attachment is the foundation on which a child’s physical, cognitive, psychological, and emotional development rests. This relationship between the dyad does not begin at birth but rather prior to conception or any time throughout pregnancy. Our understanding of how this relationship develops between a mother and her fetus remains largely intangible for researchers and clinicians alike as it is a highly complex process with many variables influencing the evolving bond. Situated within a poststructural critical feminist framework, the purpose of this qualitative study using a grounded theory approach was to gain a better understanding of how women who use substances during pregnancy experience the process of a developing relationship with their fetuses, and to identify intersecting variables that may influence their health behaviours. Five main categories emerged including choosing the mothering path, balancing the risks, needing safe passage, breaking the cycle, and mothering against all odds. All of the women in the study described feeling an increase in maternal–fetal attachment as the pregnancy progressed and demonstrated efforts to reduce substance use, engage with the health care system, and improve dietary choices to limit negative consequences for their developing fetuses. Barriers to changing health behaviours were identified by the participants as well as by health care providers working with this population. In gaining a deeper understanding of the variables that influence maternal–fetal attachment in women who use substances and development of a substantive theory, nursing practice may be informed by providing direction around how best to support harm reduction approaches in this population.