Substance Misuse in Pregnancy - NHS Lothian

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Assessing and managing child care risk during pregnancy Many pregnant women who have substance misuse problems worry that they will be referred to social services or their baby will be taken into care purely because they use drugs. Raising this subject early and discussing their concerns openly will foster a more trusting relationship. It is important to reassure women that substance misuse, in itself, is not sufficient reason to assume inadequate parenting or child care. They need to know, however, that if there are specific concerns about the safety or welfare of the child then social work will need to do an assessment and get involved, but that this policy is the same for everyone, whether or not they use drugs. This advice is mentioned in the information leaflet ‘Pregnant… and using drugs or alcohol?’ (see appendix 11). Many different factors affect the health and development of children. Parental drug and alcohol use is just one factor. Research evidence does not support the assumption that parental substance misuse will automatically lead to child neglect or abuse (Scottish Executive 2003). Indeed, a number of case controlled studies in Britain have found no significant differences in the health and development of children in drugusing households compared to non-drug using households (Ross et al 1995, Burns et al 1996). Becoming ‘drug free’ should not be a requirement for parents to keep their children living with them. Parents who stop using drugs or control their drug intake are not necessarily better or safer parents. Some parents will have poor parenting skills for reasons other than their substance misuse as many risk factors also occur in non-drug using families (Scottish Executive 2003). However, a chaotic drug or alcohol using lifestyle may affect child safety and the child’s health and development in a number of ways and is always a factor to be considered. Infants, in particular, are vulnerable to the effects of physical and emotional neglect or injury which can have damaging effects on their long-term development. Substance Misuse in Pregnancy 95
A number of childcare problems have been associated with parental substance misuse (Scottish Executive 2003, ACMD 2003). Some of these include: • Inconsistent caring • Inadequate supervision • Lack of stimulation • Inadequate and unsafe accommodation • Social isolation and stigma • Exposure to violence and criminal behaviour • Emotional or physical neglect or abuse Resulting in… • Failure to thrive • Accidental injury • Emotional difficulties • Behavioural difficulties • Poor social development • Poor cognitive and educational attainment Professionals who are involved with children and families need to remember that good inter-agency communication and collaboration in the care process is essential. It is important to obtain consent from the woman early to share information with other professionals and agencies (see consent form in appendix 5). No professional, however, can guarantee absolute confidentiality as both statute and common law accepts that information may be shared in certain circumstances. Child care risk assessment should cover issues such as existing parenting skills, child safety, as well as the physical, cognitive, emotional and social development of children. Drug and alcohol specialist workers that lack child care and parenting expertise should consult with and involve other professionals and agencies who do have this expertise. The Scottish Executive (2003) document ‘Getting Our Priorities Right: Good practice Guidance for working with Children and Families affected by Substance Misuse’, appendix II, includes a helpful checklist for collating information on substance misuse and its impact on parenting (download from www.scotland.gov.uk). Substance Misuse in Pregnancy 96
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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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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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� Swaddling of the baby will help
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Babies with severe symptoms usually
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Page 69 and 70: Substitute prescribing Lothian has
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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 89 and 90: Introduction Key Risk points assess
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Page 95 and 96: Intrapartum care (labour and childb
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Page 103 and 104: Women who are Hepatitis B positive
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Page 107 and 108: Postnatal care The care of a pregna
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Page 111: Introduction Assessing and managing
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
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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
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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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Page 155 and 156: Management of HIV positive pregnant
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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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