Dr Emma Smith is a Research Associate at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London. She joined the Institute in November 2021 as a postdoctoral researcher, contributing to interdisciplinary projects at the intersection of mental health, substance use, and maternal care. Emma earned her PhD from the University of Worcester, where she also served as an Associate Lecturer in the School of Nursing and Midwifery. She holds a Master of Public Health from the University of Dundee and a Bachelor of Arts in Anthropology from the University of Georgia. Her research focuses on the perinatal experiences of women who use drugs, with a particular interest in applying creative and participatory methodologies to explore the complexities of substance use and care. Emma is committed to producing research that informs inclusive, compassionate policy and practice in health and social care.

Abstract

‘I think they don’t realise being a parent is already difficult’: Using photovoice to understand the postpartum experience of women engaged with drug treatment during pregnancy

Pregnant women who use drugs often face complex health and social care needs, yet their experiences of postpartum care remain under-explored. In the UK, retaining custody of infants is closely linked to abstinence – including from opioid substitution therapies – and compliance with intensive scrutiny. This study explored how women who use substances experience postpartum care, examining how systems of observation, judgment, and control shape maternal identity support provision. A Photovoice methodology was used to capture the lived experiences of three women who accessed perinatal substance use treatment. Participants received digital cameras and participated in interviews and a focus group to document their perspectives visually and narratively. The data was analysed using Reflexive Thematic Analysis, with a case study methodology adopted to allow for detailed, nuanced exploration of each participant’s verbal and visual contributions. Participants described navigating persistent surveillance that shaped their postpartum care experiences. They internalised feelings of judgment and inadequacy, often tied to rigid expectations of ‘good’ motherhood. While some professional interactions were compassionate, these were overshadowed by broader systems of control. Parenting decisions were closely scrutinised, leaving little room for autonomy or tailored support, reinforcing a sense of disempowerment in their early experiences of motherhood. Postpartum care for women with substance use histories often centres on compliance and abstinence, reinforcing stigma through surveillance. A shift toward relational, non-judgmental, and flexible support is needed that recognises the impact of monitoring on maternal well-being. This study also highlights the value of visual methods in helping women express and reclaim their maternal experiences in ways that reflect their own realities.