Saving Mothers' Lives: - Public Health Agency for Northern Ireland

166
12 Deaths from psychiatric causes
Drug and alcohol abuse
The provision of drug and alcohol services varies across the country with some integrated services while in
other areas there are separate drug services and alcohol teams. Given that poly-substance misuse i.e. alcohol
and sedatives often in combination with opiates and alcohol has become the norm, it would be appropriate for
this vulnerable group of women to have their drug and alcohol addiction treated in the same setting.
Need for integrated specialist care
Although there are examples of truly outstanding integrated care, in assessing these cases it is far more
usual to fi nd a lack of integration between community midwifery and specialist midwives and hospitalbased
obstetric care. Additionally, it is also evident that the continuing lack of integration between addiction
services and maternity services also results in little or no information being passed between the two
services. It is recommended that integration be achieved in each maternity service ideally by joint service
provision between addiction services and maternity services for these vulnerable women but, where that is
not possible, by joint discussion of care plans between services to improve the information held by each.
A number of women who died were managed by their GP and midwife without the involvement of drug
treatment services and an obstetrician. The women’s methadone was prescribed by their GP and often there
was little awareness of the extent of their continuing use of street drugs. Women with substance misuse
problems in pregnancy should not be managed by GPs and midwives alone. They should be fast-tracked
to integrated care nested within maternity services, the so-called “one stop shop”. This should comprise
both specialist midwife and obstetrician, drug treatment professionals, social workers and other relevant
professionals and resources so that multidisciplinary and multi-agency care can be provided on one site.
Identifying substance misuse
There remains an issue of under-identifi cation of women with problematic substance abuse within
maternity services. At the fi rst visit maternity staff providing antenatal care for pregnant women should
routinely ask for any history or present consumption of prescribed and non-prescribed, legal and illegal
substances including tobacco and alcohol. Staff may require training in taking an addiction history as well
as providing information on local specialist drug and alcohol services and ongoing support in managing this
group of women.
All current guidelines recognise the need for an accurate assessment of drug and alcohol use, the need for
associated social problems to be addressed and emphasise the importance of an integrated multi-agency
approach. It is recommended that local protocols should be in place for effective collaboration between
agencies and services, these should prescribe the arrangements for assessment and ongoing care with
the ideal being that an integrated service should be available to these women.
Communication
In only a very few deaths does there appear to be any integration, communication or correspondence
between addiction services and maternity services. Additionally, GPs are providing little or no information
to obstetricians and midwives of a woman’s past drug or alcohol history, with the history therefore not being
revealed until late in the pregnancy. This further strengthens the recommendation made throughout this
Report, that GPs actively inform obstetricians and midwives of any knowledge of a woman’s past history of
drug or alcohol misuse or addiction as early as possible in any pregnancy.
Co-existing mental health problems