Substance Misuse in Pregnancy - NHS Lothian

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associated with detrimental effects on infant development. Postnatal depression is assessed using the Edinburgh Postnatal Depression Score (EPDS) screening tool and augmented by a multi-disciplinary Integrated Care Pathway (ICP). Health Visitors and GP’s are trained to use these tools to improve the care of women at risk. Staff should make themselves familiar with the new SIGN guideline (2003) ‘Postnatal Depression and Puerperal Psychosis’ (www.sign.ac.uk). Sudden Infant Death Syndrome (SIDS) Maternal tobacco use, as well as drug and alcohol misuse are associated with an increased risk of Sudden Infant Death Syndrome (‘SIDS’ or ‘cot death’). All parents who use these drugs should be given advice about how to reduce the risk of cot death. The leaflet ‘Reducing the risk of cot death’ (produced by the Scottish Executive 2000) is included in the hospital ‘discharge pack’. Risk of relapse In the postnatal period, increased drug and alcohol use is common. For women who have managed to reduce their intake during pregnancy or even come off drugs or alcohol, the risk of relapse to former levels of drug taking is high. There are a number of reasons for this, including: • feeling that it’s now OK to use again • relief at having a ‘normal’ baby • wanting to celebrate! • the stress of caring for a new born baby (perhaps with NAS) • ‘baby blues’ or postnatal depression • poor support from partner or family • anxieties about motherhood It is important for professionals to acknowledge that relapse is common. Re-assessment of substance use and careful drug management is essential at this time, along with support to remain stable and to prevent relapse. Ensuring the woman is engaged with a specialist drug and alcohol agency that can provide a relapse prevention service may be an important part of the postnatal care plan. Substance Misuse in Pregnancy 92
Relapse prevention support work can include: � helping parents understand relapse as a process and as an event � raising awareness of ‘high-risk’ situations and factors that might lead to relapse � exploration of how to anticipate, avoid or cope with these high-risk situations � acquisition of skills (cognitive and behavioural) to implement relapse prevention strategies � anxiety and stress management education � confidence building and improving self–efficacy � strengthening existing positive coping strategies and other personal attributes � life / social skills education (e.g. assertiveness, resistance and dissuasion skills, alternative activities to drug/alcohol use) Substance Misuse in Pregnancy 93
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Substance Substance misuse misuse i
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This pack has been approved by Loth
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Page Drugs and their effects on the
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Appendices ........................
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Introduction Welcome to the ‘Subs
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Please note: 1. The terminology use
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Introduction Key points Setting the
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Pre-conceptual care � Agencies in
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Substance Misuse in Pregnancy 14
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Setting the scene The extent of the
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Organisational difficulties Profess
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• Financial problems (including d
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The important role of partners need
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ecognises that a woman’s needs ar
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Guidelines on good practice This se
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An assessment of the partner’s dr
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Care management Some women with sub
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Introduction Information and guidel
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anxiety related problems and can in
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Substance Misuse in Pregnancy 34
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Drugs and their effects on the deve
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Effects of tobacco The significant
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Effects of drugs (illicit and presc
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• fetal death in-utero (miscarria
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Introduction Key points Setting Neo
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• poor feeding ability (hungry bu
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monitored. Any drug treatment admin
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Page 69 and 70: Substitute prescribing Lothian has
Page 71 and 72: drug use should be the first goal t
Page 73 and 74: A final word: Over the years, much
Page 75 and 76: Introduction Key points Setting the
Page 77 and 78: Amenorrhoea does not necessarily me
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Page 81 and 82: Antenatal care Receiving good quali
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Page 85 and 86: usually possible to be quite reassu
Page 87 and 88: can be more serious in women with s
Page 89 and 90: Introduction Key Risk points assess
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Page 95 and 96: Intrapartum care (labour and childb
Page 97 and 98: There may be placental insufficienc
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Page 107: Postnatal care The care of a pregna
Page 111 and 112: Introduction Assessing and managing
Page 113 and 114: A number of childcare problems have
Page 115 and 116: � Report your concerns to the Chi
Page 117 and 118: Finally, it is important to remembe
Page 119 and 120: Services List Services providing ma
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Page 123 and 124: Drug services in Lothian Most speci
Page 125 and 126: Local drug services � Locality Cl
Page 127 and 128: Alcohol services in Lothian Most sp
Page 129 and 130: Other services in Lothian A variety
Page 131 and 132: Introduction Key points Setting Fur
Page 133 and 134: � Royal College of Obstetricians
Page 135 and 136: General � Scottish Executive webs
Page 137 and 138: References Abel EL, (1998) ‘Fetal
Page 139 and 140: NICE (National Institute for Clinic
Page 143 and 144: Drug/Alcohol related problem: refer
Page 147 and 148: INDEX Alcohol, 37-38, 52-56, 84 scr
Page 149 and 150: Introduction Key Appendices points
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It is good practice therefore to of
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Introduction Appendix 4: Model Care
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Introduction Appendix 5: Key Consen
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Introduction Key points Setting App
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Appendix 9: Introduction Midwifery
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Alcohol use (tick average weekly co
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Community Baby developed NAS sympto
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Neonatal Abstinence Syndrome Assess
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Drug Drug use use in in pregnancy p
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aby. If you want to come off, it is
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Labour Labour and and childbirth ch
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Midwifery Midwifery care care staff
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Helpful Helpful numbers numbers My
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Produced by NHS Lothian © 2003
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This leaflet provides you with info
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Parents are encouraged to keep a cl
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Breastfeeding Breastfeeding and and
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Substance Misuse in Pregnancy - NHS Lothian

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