Substance Misuse in Pregnancy - NHS Lothian

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MODEL CARE PATHWAY: SUBSTANCE MISUSE IN PREGNANCY Pre-conceptual Care Confirmation of pregnancy 12 weeks… Booking appointment Multidisciplinary Assessment � Advice on reproductive health and contraception � Advice on sexual health � Advice on pregnancy care � ‘Ready Steady Baby’ book � Woman to attend GP (e.g. health advice & folic acid) � Refer to Midwifery Team � Arrange scan � Follow antenatal ‘Care Pathway’ � Assessment of drug use (including tobacco and alcohol) � T-ACE (alcohol questionnaire) � Antenatal Liaison Form (Substance Misuse) � Leaflet ‘Pregnant… and using alcohol or drugs?’ � Refer to drug/alcohol specialist � Blood Borne Virus testing – if positive, follow agreed protocol � Risk assessment � Commence ‘infant feeding’ checklist � Consent form for multidisciplinary / multi-agency working � If woman does not attend booking – follow-up by Midwife 16 weeks… Antenatal appointment � Discuss and agree care plan � Discuss and agree management of drug/alcohol use Implement care plan � Identify ‘lead professional’ / ‘care co-ordinator’ � Give handheld records 22 weeks… Antenatal appointment � Monitor drug/alcohol use � Monitor progress of care 28 weeks… Antenatal appointment � Case discussion / care plan review meeting � Reassess social circumstances / risk Review care plan � Discuss breastfeeding � Growth scan / fetal monitoring 32 weeks… Antenatal appointment � Start preparation for parenthood � Discuss birth plan � Discuss NAS and give parent information leaflet � Child protection case conference (if needed) 36 weeks… Antenatal appointment � Preparation for parenthood � Assess fetal growth � Discuss labour and delivery (include protocol re prescription) 38 weeks… Antenatal appointment � Preparation for parenthood � Monitor drug/alcohol use – update antenatal liaison form Term… (40 weeks) Childbirth � Pregnancy outcome liaison form � Neonatal Abstinence Syndrome (NAS) assessment and care � Discharge plan (include prescription arrangements) � Discharge pack – discuss info on SIDS (cot death) � Follow postnatal ‘Care Pathway’ 10 days… Postnatal care � Continue multidisciplinary support / postnatal care plan � Continue NAS assessment and care (if required) Review care plan � Monitor drug / alcohol use � Relapse prevention support � Midwife ends care (day 10 to 28) � Home visit by Health Visitor
Introduction Appendix 5: Key Consent pointsform for multi-disciplinary working Setting the scene Framework for care Guidelines on good practice
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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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Management of substance use in preg
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Scottish Executive advice recommend
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If a ‘hazardous’ drinking score
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Assessing drug related problems It
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Substitute prescribing Lothian has
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drug use should be the first goal t
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A final word: Over the years, much
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Amenorrhoea does not necessarily me
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Pre-conceptual advice on drug use c
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Antenatal care Receiving good quali
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the antenatal ward, labour ward, an
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usually possible to be quite reassu
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can be more serious in women with s
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Introduction Key Risk points assess
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for the women and can make attendan
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These documents contain important i
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Intrapartum care (labour and childb
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There may be placental insufficienc
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states she is taking the baby home
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Women who are Hepatitis B positive
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Postnatal care The care of a pregna
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Relapse prevention support work can
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Introduction Assessing and managing
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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
Page 121 and 122: with a drug dependency who are on s
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 141 and 142: Introduction Key points Setting the
Page 143 and 144: Drug/Alcohol related problem: refer
Page 145 and 146: Substance Misuse in Pregnancy 124
Page 147 and 148: INDEX Alcohol, 37-38, 52-56, 84 scr
Page 149 and 150: Introduction Key Appendices points
Page 151 and 152: Substance Misuse in Pregnancy 128
Page 153 and 154: Blood Borne Viruses and Pregnancy H
Page 155 and 156: Management of HIV positive pregnant
Page 157 and 158: east fed after these are given. The
Page 159 and 160: It is good practice therefore to of
Page 165: Introduction Appendix 4: Model Care
Page 169 and 170: Introduction Key points Setting App
Page 175 and 176: Appendix 9: Introduction Midwifery
Page 177 and 178: Alcohol use (tick average weekly co
Page 179 and 180: Community Baby developed NAS sympto
Page 181 and 182: Neonatal Abstinence Syndrome Assess
Page 183 and 184: Drug Drug use use in in pregnancy p
Page 185 and 186: aby. If you want to come off, it is
Page 187 and 188: Labour Labour and and childbirth ch
Page 189 and 190: Midwifery Midwifery care care staff
Page 191 and 192: Helpful Helpful numbers numbers My
Page 193 and 194: Produced by NHS Lothian © 2003
Page 195 and 196: This leaflet provides you with info
Page 197 and 198: Parents are encouraged to keep a cl
Page 199: Breastfeeding Breastfeeding and and
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Substance Misuse in Pregnancy - NHS Lothian

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