Substance Misuse in Pregnancy - NHS Lothian

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Pregnancy Outcome Form (Substance Misuse) SM203 Mother’s name: ........................................................................…… Mother’s d.o.b.: …………………………………………… Baby’s name: ................................................................................. Address: ........................................................................................................................................................................ �------------------------------------------------------------------------� Postcode: EH _ _ / _ (only 1 st number of 2 nd part) Mother’s Unit No .......................................... Baby’s SM number:……………………………………………………… Mother’s Chi No.:……………………………………….. Delivery date: ..........................................................…… Baby’s Chi No.:…………………………………………… Gestation: ...............................................................………. APGARs: ...........................................................……….. Birth weight: .............................................................….. Cord pH: …………………………………………………………………. Birth length: ................................................................... Head Circumference: …………………………………………… Labour ward (please give details… if none state ‘none’) Complications in labour? ............................................................................................................................................ Pain relief during labour? ......................................................................................................................................... Mode of delivery? ………………………………………………………………………………………………………………………………………………….. Complications of delivery? ........................................................................................................................................ Problems at birth? ...................................................................................................................................................... Postnatal ward Baby stayed for 72 hours observation?… Yes/No Neonatal withdrawal symptoms developed within 72 hours?… Yes/No If yes, severity… Mild /Moderate/ Severe Drug treatment administered? .......................................................................................................................……… Medication on discharge? …………………………………………………………………………………………………………………………………….. Breast or bottle feeding on discharge? …………………………………………………………………………………………………………… Other comments? ………………………………………………………………………………………………………………………………………………….. Postnatal ward discharge date: .....................................................................................................................……….. If mother HIV/Hepatitis C positive, baby referred for follow-up?...Yes/No Bloods taken? Yes/No Neonatal Unit (RIE) / SCBU (West Lothian) Admission date: ........................................................................................................................................………………… Reason for admission: ........................................................................................................................................……… Neonatal withdrawal symptoms? None / Mild / Moderate /Severe Drug treatment administered? ..........................................................................................................................…… Medication on discharge?……………………………………………………………………………………………………………………………………… Breast or bottle feeding on discharge?…………………………………………………………………………………………………………… Other comments? ………………………………………………………………………………………………………………………………………………….. Neonatal Unit / SCBU discharge date: ...........................................................................................................…… Toxicology Result: …………………………………………………………………………………………………………………………………………………. Substance Misuse in Pregnancy: Appendix 9 / November 2003 / PILOT
Community Baby developed NAS symptoms after discharge from hospital?… Yes/No Baby readmitted?… Neonatal Unit, RIE � SCBU, St John’s � RHSC � St John’s Children’s Ward � Date of readmission: ………………………………………………………… Infant feeding at day 10?… Breast fed / Bottle fed Continued drug / alcohol use whilst breast feeding? (please detail) ................................….......................... .......................................................................................................................................................................................... Date of postnatal case discussion: ..................................................................................................................…… Professionals involved discussion?........................................................................................................................... ……………………………………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………………………………. Decisions made?........................................................................................................................................................... ……………………………………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………………………………. Child protection case conference held (post birth)?... Yes/No SIDS? (include details) .........................................................................................................................................…. Age of baby on last midwifery visit? ………………………………… days old Date of last midwifery visit? ……………………………………………………………. Name of midwife………………………………………………………………………………………. Details of Health Visitor Name: ............................................................................................................................................................................. Address: ........................................................................................................................................................................ .......................................................................................................................................................................................... Tele. ................................................... Form completed by: .................................................................................................................................................. Midwifery Team:…………………………………………………………………………………………………………………………………………………… Form completed on (date): ....................................................................................................................................... *Form SM203. Photocopy form and send to Link Midwife (Substance Misuse) after day 10. Substance Misuse in Pregnancy: Appendix 9 / November 2003 / PILOT
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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
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� Report your concerns to the Chi
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Finally, it is important to remembe
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Services List Services providing ma
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with a drug dependency who are on s
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Drug services in Lothian Most speci
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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 and 166: Introduction Appendix 4: Model Care
Page 167 and 168: Introduction Appendix 5: Key Consen
Page 169 and 170: Introduction Key points Setting App
Page 175 and 176: Appendix 9: Introduction Midwifery
Page 177: Alcohol use (tick average weekly co
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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