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

It is known that women presenting with drug and/or alcohol misuse have a high incidence of mood disorders,
estimated to be around 30%. On occasions the same woman may be receiving treatment from the addiction
services, her GP and from generic mental health services and may be receiving anti-depressants whilst
still using illicit substances that adversely affect her mood. Each such woman requires a lead agency to
take responsibility for the overall management and co-ordination for further care as the combination of antidepressants
and stimulants in undesirable and treatment by several agencies may be confusing and lead to
inappropriate prescribing of anti-depressants rather than treatment for stimulant misuse:
A young socially deprived woman, living in a hostel, died some weeks after delivery of her second child
from an accidental overdose of heroin. She was being seen by the alcohol treatment service at the time
and was awaiting inpatient detoxifi cation. She died a number of days after her infant had been placed
into care. The alcohol treatment services appear to have been unaware that she was also using heroin.
In the past, she had been treated by alcohol services for her alcoholism, drug addiction services for her
heroin addiction and adult psychiatric services as an inpatient and in the community. Her GP had been
prescribing anti-depressants.
This case also highlights the importance of communication between all those involved.
Care beyond pregnancy
Of all of the deaths due to, or associated with substance misuse, as reported earlier in this Chapter, it is
noteworthy that the majority took place after 42 days after birth. It is a matter of concern that whilst drug
and alcohol agencies actively recruit women into treatment whilst pregnant, the treatments are largely
directed at stabilising the substance misuse during pregnancy. Post-delivery, particularly if the child is
removed from the woman’s care, many of these women then disengage themselves or are discharged
from treatment. Therefore further efforts are required to retain substance misusing women in treatment
programmes after pregnancy.
Occasional social misuse
Three women died by falling over when drunk, none of whom had evidence of an alcohol dependency.
Two others died from amphetamine toxicity but there is no evidence that they had either previous contact
with drug services or had any enduring drug problem. The third woman died from solvent inhalation. These
deaths raise an issue as to how to better advise recreational substance users on the risks of social drug
and alcohol use and whether services have a part to play in primary prevention of deaths from drug or
alcohol misuse. For example:
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