Substance Misuse in Pregnancy - NHS Lothian

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Framework for care A number of recent governmental publications have provided a broad set of principles and guidelines on good practice for working with pregnant women and families affected by drug and alcohol related problems. These include: � ‘Drug Misuse and Dependence – Guidelines on Clinical Management’, Annex 5: ‘Pregnancy and Neonatal Care’, Department of Health (1999) � ‘A Framework for Maternity Services in Scotland ‘, Scottish Executive (2001) � ‘Integrated Care for Drug Users’, Effective Interventions Unit (2002) � ‘Plan for Action on Alcohol Problems’, Scottish Executive (2002) � ‘Getting Our Priorities Right’, Scottish Executive (2003) � ‘Hidden Harm: responding to the needs of children of problem drug users’, The Advisory Council on the Misuse of Drugs report (2003) Philosophy of approach The philosophy of approach outlined here reflects the central themes from these policy documents as well as recommendations from leading experts in the field. Overall, the approach to care needs to be: � women and family centred � non-judgemental � pragmatic, with an emphasis on harm reduction � holistic � provided by a multi-disciplinary and multi-agency team Women and family centred approach Pregnancy and the transition into parenthood is a significant life event. For women who have problems related to alcohol and drug misuse it offers opportunities as well as risks. These women have the same hopes and aspirations for family life and the same anxieties about pregnancy, childbirth and motherhood as other women (Ford & Hepburn 1997). For service providers, the challenge is to offer the right kind of support that will allow them to minimise the risks as much as possible and to make the most of available opportunities. This means that treatment and care needs to be women and family centred. Substance Misuse in Pregnancy 21
The important role of partners needs to be recognised, and professionals need to ensure that, where appropriate, they are encouraged and supported to take a full and active role in pregnancy, childbirth and postnatal care. Women and their partners need to be able to make fully informed choices about their care. They need timely, relevant and easily accessible information to help them make the choices they face. They also need prompt access to any treatment and care that they might need. Maternity care should be tailored to the needs of the individual woman and her family, focusing on the safety of mother and baby. It should take into account: � the needs and wishes of the woman and her family � her right to privacy and dignity throughout her pregnancy � her cultural values, beliefs, attitudes, and chosen lifestyle A family centred approach will create an atmosphere of normalisation and partnership that will engage the woman and her partner and foster the best possible outcome for mother and baby. Non-judgemental approach Service providers need to adopt a truly professional approach that is not led by views which are distorted by prejudice or limited by conventional stereotypes (Klee, Jackson & Lewis 2002). Professionals need to continually examine their approach to care so that they can account for their practice in terms of what is in the best interests of the woman and her baby and what is in accordance with the best available evidence and best practice. Establishing early contact with pregnant women who have substance misuse problems and retaining them in treatment and care is vital. This can best be achieved by creating a non-judgemental environment. Providing care with compassion, reassurance and encouragement will facilitate good contact. A non-judgemental approach is also a pre-requisite for obtaining the necessary details of the woman’s substance misuse and social circumstances. The woman needs to feel supported throughout her pregnancy and beyond. This means that professionals need to create a positive pregnancy experience for the woman, irrespective of risk and despite any difficulties that she may have. Substance Misuse in Pregnancy 22
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 and 22: Organisational difficulties Profess
Page 23 and 24: • Financial problems (including d
Page 25: Introduction Key points Setting the
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
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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
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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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Introduction Key points Setting the
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Women who are Hepatitis B positive
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Substance Misuse in Pregnancy 90
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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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INDEX Alcohol, 37-38, 52-56, 84 scr
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Introduction Key Appendices points
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Blood Borne Viruses and Pregnancy H
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Management of HIV positive pregnant
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east fed after these are given. The
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It is good practice therefore to of
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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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