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

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12 Deaths from psychiatric causes
A comfortably off employed older woman with other children died from acute amphetamine
toxicity some weeks after the birth of her next child. She had no history of mental health problems
and was well known to her health visitor and GP who did not suspect that she ever used illicit
substances. Her mental health was said to be good during pregnancy and the postpartum period
and she was seen by health professionals the day before she died and said to be very well. It
appears that this woman was not a habitual drug user but merely an occasional recreational one.
Another older woman living in comfortable circumstances with older children, died from a head
injury sustained after she had fallen downstairs when drunk. A few days earlier she had had a
medical termination of pregnancy for a fetal abnormality. This woman had no history of previous
mental health problems nor alcohol misuse. She had good compassionate care around the time
of her termination but appears to have become distressed that evening and drunk to excess in
order to get to sleep.
Domestic abuse
There is a clear association of domestic abuse with substance misuse, either as a refl ection of lifestyle
e.g. working in the sex industry, or as a consequence of living with a substance misusing partner. Again
this strengthens the recommendation in this, and previous Reports, that all obstetric services and all drug
and alcohol specialist services actively enquire about domestic abuse at assessment and within ongoing
treatment. Attention to this is variable across addiction services in the UK:
A woman with longstanding heroin and alcohol misuse was murdered in late pregnancy by
her drug misusing partner. She had been the victim of a number of serious assaults at the
hands of her partner over the previous two years including one shortly before her death. She
had presented to her GP late in pregnancy requesting a termination but her pregnancy was
too advanced to proceed. She was seen only one occasion before her death by a drug liaison
midwife but no mention was made by her GP or the woman herself of her domestic abuse.
Deaths from medical conditions
In addition to the deaths of substance misusers due to suicide or to accidental overdoses of illicit drugs,
there were at least 23 further deaths in which substance misuse played a major role. Some of these
deaths, particularly in those with alcohol dependency were directly caused by the psychiatric disorder, for
example pancreatitis. Other deaths were due to the consequences of abuse, for example overwhelming
infection or the failure of the woman and her carers to access timely medical help:
A woman died a few days following delivery from streptococcal septicaemia. She had a long
history of intravenous heroin use and was in a poor physical state with multiple injection
abscesses. After referral to social services in early pregnancy she failed to attend the majority
of her antenatal visits and disengaged with the drug addiction services. A child protection case
conference was held prior to delivery. She was admitted in labour at term, physically unwell but
left hospital. The community midwife was unable to gain access to her home and presented just
after birth in extremis some days later.
A young homeless woman died from bacterial endocarditis in late pregnancy. She had a long
history of multiple drug abuse and had been using intravenous heroin for some years. She did
not attend any maternity appointments after her midwife referred her to social services. A few
weeks prior to her death, she saw a GP with fever and malaise and was prescribed antibiotics
for a presumed diagnosis of a urinary tract infection. She did not complete the course of her