Substance Misuse in Pregnancy - NHS Lothian

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Introduction Key points Setting the scene Framework for care Guidelines on good practice Guidelines on good practice
Guidelines on good practice This section of the resource pack outlines guidelines on good practice for working with pregnant women who have substance misuse problems. The care process It is important that all professionals involved with substance-misusing women follow a clear ‘pathway of care’, from pre-conception through to parenthood. A model ‘care pathway’ is included in appendix 4. The care process involves assessment, planning care and agreeing an individual care plan, implementing care, and reviewing care. These key tasks in the care process are outlined below, along with a checklist of topics that are relevant to each stage of the process, many of which are covered in the course of routine health care as well as drug and alcohol treatment and social care service provision. Assessment Assessment should be holistic and continuous throughout pregnancy. It should take into account the woman’s physical and psychological health needs, her social circumstances, her partner’s drug and alcohol use, an assessment of risk as well as her own drug use (including alcohol and tobacco). It may involve a number of different professionals contributing to the assessment process over time, including the General Practitioner, midwifery, obstetric and paediatric staff, the Health Visitor, Drug and Alcohol Worker and Social Worker. An assessment of physical health needs should include such topics as: � Past obstetric / gynaecological history � General health status � Nutrition (e.g. diet, weight, anaemia) � Dental health � Exposure to infections (e.g. Blood Borne Viruses, Sexually Transmitted Infections) � Complications from injecting (including venous access) � Accidents or injuries � Difficulty getting registered with GP Substance Misuse in Pregnancy 25
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
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Page 19 and 20: Setting the scene The extent of the
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Page 23 and 24: • Financial problems (including d
Page 27 and 28: The important role of partners need
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Page 35 and 36: Care management Some women with sub
Page 37 and 38: Introduction Information and guidel
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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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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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