Substance Misuse in Pregnancy - NHS Lothian

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surveillance and restricted options for treatment and care (Klee, Jackson & Lewis 2002). Negative societal views and professional attitudes coupled with discriminatory practice have deterred women from seeking help. They may appear to neglect their condition and that of their babies but in reality it may be the service’s attitudes and approach that have excluded them from care (Morrison 1999). Research evidence Lack of good data and research evidence on the effects of illicit drug use on the fetus and baby has led to some confusion and exaggeration of risk. Providing balanced and factual information to women so that they can make informed choices in pregnancy has proved difficult and women continue to receive inconsistent and contradictory advice. Women’s fears Not surprisingly, pregnant women who have substance misuse problems frequently report a number of concerns (Scottish Executive 2003) including: • Fear that child protection agencies will be contacted automatically • Fear that her baby will be taken into care • Fear and confusion over whether her drug use will cause fetal damage • Fear that she will be blamed if anything goes wrong with her pregnancy • Fear of being thought of as un uncaring or ‘unfit’ mother if she doesn’t manage to come off or reduce her drug use • Feeling guilty and ‘to blame’ for her baby experiencing withdrawal symptoms Poor social circumstances Drug and alcohol related problems are commonly associated with socioeconomic deprivation and poor social circumstances. These include: • Poor support from family and friends • Poor support from a substance-misusing partner • Drug related criminal activity and legal problems (e.g. outstanding charges, impending court cases, community service order, probation, prison history, drug treatment and testing orders) • Violence (e.g. substance misuse-related or domestic abuse) Substance Misuse in Pregnancy 18
• Financial problems (including debts, fines and problems with welfare benefits) • Housing problems (including homelessness, insecure or unsuitable housing) Maternal health problems Injecting drug use and harmful levels of drinking are associated with poor maternal health. This may include: • Malnutrition and anaemia • Respiratory problems • Poor dental hygiene • Blood borne virus infections (HIV, hepatitis B, hepatitis C) • Complications from injecting (such as abscesses, endocarditis, septicaemia etc) • Liver disease • Accidental injury • Overdose and maternal death • Mental health problems (such as anxiety, depression, self harm, psychosis) Chaotic lifestyle Drug and alcohol related problems are commonly associated with a chaotic lifestyle and may result in the woman receiving poor maternity care. For example: • Late pregnancy booking • Poor attendance for antenatal care • Not registering with a general practitioner • Poor attendance for parenthood education • Late presentation during labour • Early discharge home after delivery Obstetric and paediatric problems Drug use (including alcohol and tobacco) impacts on obstetric and paediatric morbidity and mortality. Increased rates of low birth weight, pre-term delivery, Sudden Infant Death Syndrome (SIDS or ‘cot death’) and Neonatal Abstinence Syndrome in babies are the most commonly reported problems. The effects of specific substances on the developing fetus and baby are outlined later in the pack (see page 35). Substance Misuse in Pregnancy 19
Page 1 and 2: Substance Substance misuse misuse i
Page 3 and 4: This pack has been approved by Loth
Page 5 and 6: Page Drugs and their effects on the
Page 7 and 8: Appendices ........................
Page 9 and 10: Introduction Welcome to the ‘Subs
Page 11 and 12: Please note: 1. The terminology use
Page 13 and 14: Introduction Key points Setting the
Page 15 and 16: Pre-conceptual care � Agencies in
Page 17 and 18: Substance Misuse in Pregnancy 14
Page 19 and 20: Setting the scene The extent of the
Page 21: Organisational difficulties Profess
Page 25 and 26: Introduction Key points Setting the
Page 27 and 28: The important role of partners need
Page 29 and 30: ecognises that a woman’s needs ar
Page 31 and 32: Guidelines on good practice This se
Page 33 and 34: An assessment of the partner’s dr
Page 35 and 36: Care management Some women with sub
Page 37 and 38: Introduction Information and guidel
Page 39 and 40: anxiety related problems and can in
Page 41 and 42: Substance Misuse in Pregnancy 34
Page 43 and 44: Drugs and their effects on the deve
Page 45 and 46: Effects of tobacco The significant
Page 47 and 48: Effects of drugs (illicit and presc
Page 49 and 50: • fetal death in-utero (miscarria
Page 51 and 52: Introduction Key points Setting Neo
Page 53 and 54: • poor feeding ability (hungry bu
Page 55 and 56: monitored. Any drug treatment admin
Page 57 and 58: � Swaddling of the baby will help
Page 59 and 60: Babies with severe symptoms usually
Page 61 and 62: Management of substance use in preg
Page 63 and 64: Scottish Executive advice recommend
Page 65 and 66: If a ‘hazardous’ drinking score
Page 67 and 68: Assessing drug related problems It
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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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
Page 85 and 86:
usually possible to be quite reassu
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can be more serious in women with s
Page 89 and 90:
Introduction Key Risk points assess
Page 91 and 92:
for the women and can make attendan
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These documents contain important i
Page 95 and 96:
Intrapartum care (labour and childb
Page 97 and 98:
There may be placental insufficienc
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states she is taking the baby home
Page 101 and 102:
Page 103 and 104:
Women who are Hepatitis B positive
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Substance Misuse in Pregnancy 90
Page 107 and 108:
Postnatal care The care of a pregna
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Relapse prevention support work can
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
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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
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Other services in Lothian A variety
Page 131 and 132:
Introduction Key points Setting Fur
Page 133 and 134:
� 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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Page 143 and 144:
Drug/Alcohol related problem: refer
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Page 147 and 148:
INDEX Alcohol, 37-38, 52-56, 84 scr
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Introduction Key Appendices points
Page 151 and 152:
Page 153 and 154:
Blood Borne Viruses and Pregnancy H
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Management of HIV positive pregnant
Page 157 and 158:
east fed after these are given. The
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It is good practice therefore to of
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Page 163 and 164:
Page 165 and 166:
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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Page 173 and 174:
Page 175 and 176:
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
Page 185 and 186:
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
Page 199:
Breastfeeding Breastfeeding and and
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Substance Misuse in Pregnancy - NHS Lothian

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