Substance Misuse in Pregnancy - NHS Lothian

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Most babies who have been exposed to drugs before birth will have some symptoms after birth. Some babies experience only mild withdrawal symptoms and require no more than the usual care that all babies need. Other babies however, can have severe symptoms where they cannot feed or sleep properly and they lose weight rather than gain weight. These babies usually need medical treatment, including special nursing care and sometimes calming drugs to help them recover. Unfortunately, there is no way of telling exactly how a baby will react as there are many different factors that affect withdrawal symptoms in babies. The amount of drugs you are taking is only one factor so we like to prepare all parents just in case. What we can say is that drug withdrawal in babies is now fairly common, so you are not alone. Midwives and other maternity staff as well as Health Visitors and GPs have experience in looking after babies and can offer some good advice and help to parents. Caring Caring for for your your baby baby Mothers who are dependent on drugs are asked to stay in hospital with their baby for at least 3 days (72 hours). This is because most withdrawal symptoms in babies appear within this time period. Benzodiazepines (e.g. valium and temazepam) however, can take longer to leave the baby’s system and withdrawal signs may not show up for a week or so. In the postnatal ward you will be encouraged to breastfeed and ‘bond’ with your baby. The nurse or midwife will use a special score chart to assess the condition of your baby. You will be shown how to use the chart so you can help the nurses with this. Most babies are well enough to go home after 3 days where they can be cared for by their parents, with the help and support of the midwife, health visitor and GP. The baby needs to feed well enough and the baby will be checked to see if it is putting on enough weight.
Parents are encouraged to keep a close eye on their baby and use the special score chart. If the baby has severe withdrawal symptoms they would be admitted to the ‘neonatal unit’ or ‘special care baby unit’. Here they can get ‘tube’ feeds and calming medicine if necessary. Treatment aims to reduce the baby’s distress and to get the baby feeding and sleeping as normally as possible. Babies usually stay in the neonatal unit for about 10-14 days, but occasionally for much longer. Most admissions to the neonatal unit happen when the baby is still in hospital after birth, but babies are also admitted from home if problems become worse later on. Babies older than 2 weeks are admitted to the Royal Hospital for Sick Children (RHSC) or the Children’s Ward at St John’s Hospital. If the baby’s problems get worse at home then it is better to admit the baby earlier rather than later. This is why we are keen to offer parents extra help at home and to see how the baby is doing. We appreciate that babies with withdrawal symptoms are difficult to look after and they can require a lot of patience and may be difficult to feed and settle. Some babies can be irritable for months, but symptoms gradually improve with time.
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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
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Alcohol services in Lothian Most sp
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Other services in Lothian A variety
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Introduction Key points Setting Fur
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� Royal College of Obstetricians
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General � Scottish Executive webs
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References Abel EL, (1998) ‘Fetal
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NICE (National Institute for Clinic
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Drug/Alcohol related problem: refer
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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 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 161 and 162: Introduction Key points Setting the
Page 165 and 166: Introduction Appendix 4: Model Care
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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: This leaflet provides you with info
Page 199: Breastfeeding Breastfeeding and and
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Substance Misuse in Pregnancy - NHS Lothian

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