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

antibiotics nor returned to her general practitioner. Her drug using boyfriend noticed that she was
ill a few days before fi nding her dead in bed.
Both of these cases also highlight the additional risks that substance misusing women face when they
avoid contact with health services following the involvement of child protection social services.
There were also a number of cases when the woman’s heroin use led to the misattribution of physical
symptoms or delay in the correct diagnosis. For example:
A young single woman with an older child in care died some months after delivery from cancer.
She had a long history of heroin use and for some time had been living in very deprived
circumstances and in a state of self-neglect. She did not reveal her heroin use until later in
pregnancy following which she failed to attend for maternity appointments. She was admitted
in late pregnancy with an antepartum haemorrhage and her premature baby suffered from a
neonatal abstinence syndrome. Shortly after delivery she saw her GP, feeling unwell, and then
continued to see him with complaints of weight loss and a chest infection. Her symptoms were
attributed to her substance misuse and lifestyle. Her condition was not diagnosed until some
weeks later when she presented as an emergency to hospital shortly before her death.
Child protection
As is evident from the “Hidden Harm” 15 report, it is estimated there are between 250,000 and 350,000
children of problem drug users in the UK; this equates to one child for every problem drug user known
to the services. This represents 2-3% of children under the age of 16 in England and Wales. This Report
therefore recommends that all drug treatment agencies should record an agreed minimum consistent
set of data about the children of clients presenting to them and further recommends that information be
shared between the social services and health treatment agencies. This has undoubtedly already improved
practice and has led to multi-agency planning meetings, being convened as early as possible in the
pregnancy in an attempt to meet the multiple needs of the mother. However, paradoxically, the involvement
of social services early in the pregnancy results in some of these women disengaging from treatment to
avoid involvement from social services. It is therefore recommended that further work be done to improve
attitudes towards pregnant women who misuse drugs or alcohol, to realistically address their multiple
needs and to retain them in treatment.
Management guidelines
The care and management of pregnant women who are substance misusing, including alcohol, should
be delivered according to best practice guidelines. National guidelines for Scotland were published in
200316 , and suggested guidelines for England and Wales in 199717 . Guidelines for the management of the
pregnant woman were included in “Drug Misuse and Dependence - Guidelines on Clinical Management”,
fi rst published in 199718 , which are currently being updated. Others can be found within the Evidencebased
Guidelines for the Pharmacological Management of Substance Misuse, Recommendations from
the British Association for Psychopharmacology19 . This multiplicity of guidelines points to the need to
synthesise these into one universal guideline, and this is a recommendation of this Report.
Discussion
Whilst the number of women who died from suicide in this triennium appears to be reduced compared
to the last two Reports, it is evident that there are still problems with the identifi cation of risk in early
pregnancy and the appropriate management of that risk.
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