Substance Misuse in Pregnancy - NHS Lothian

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� Plan for postnatal care (including preparations for infant and social support) � Plan to address any risks or concerns associated with parenting skills or child care � Plan to involve other professionals and referral to other agencies � Plan for multi-disciplinary / multi-agency meeting / child protection case conference Reviewing the care plan The care plan and progress of care need to be reviewed at regular intervals throughout the pregnancy (for example at each antenatal appointment). Women with identified risks or multiple social needs may benefit from attending an organised ‘care plan review’ meeting. All parties involved in the delivery of care should be encouraged to attend review meetings or submit a brief report. If the care plan review meeting takes place around 28 weeks gestation then there will be enough time for services to be put in place in time for the arrival of the baby. The review process should include a discussion on the following topics: � Attendance for antenatal care? � Fetal health and development? � Maternal health? (including mental health) � Current smoking/alcohol/drug use? � Attendance for other health care appointments? (e.g. GP, Health Visitor or Community Mental Health Nurse) � Attendance at specialist drug/alcohol service? � Attendance for social care appointments? (e.g. social work, voluntary sector agencies) � Involvement and support of partner? � Stability of lifestyle? � Improvement in social circumstances? � Current or potential risks? � Future needs to address? � Future goals to work towards? Substance Misuse in Pregnancy 28
Care management Some women with substance misuse problems and their families will have complex health and social care needs and will require a care management approach and a comprehensive package of care during pregnancy and well into the postnatal period. In these cases, one professional needs to be identified as the ‘care co-ordinator’ to take responsibility for managing the care process. The role of this ‘lead professional’ is to ensure that the care process is fully documented, implemented and reviewed. This requires good liaison, communication and organisational skills to ensure a continuum of care is delivered in accordance with the agreed care plan for the family. Consent to share information with other professionals All professionals working with pregnant women who have substance misuse problems need to work collaboratively with other professionals and agencies in order to provide good quality care. It is important to discuss ‘joint working’ with the woman at an early stage so that informed consent can be obtained to allow information sharing. Most women are happy to agree to this once the benefits of inter-agency collaboration are explained. Information regarding her assessment, care plan and progress can then be exchanged between professionals. Although the woman may consent to ‘joint working’ she may still need reassurance about her right to privacy and should be given guidance on the Data Protection Act (1998) and the terms of professional ‘confidentiality’. This will include advice about circumstances whereby confidentiality may be breached e.g. for child protection, mental health or legal reasons. A proforma consent form is included in appendix 5. The consent form can be photocopied and sent to all professionals involved in the woman’s care (i.e. the Midwife, GP, Health Visitor, Drug/Alcohol worker, Social Worker etc). Substance Misuse in Pregnancy 29
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 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: An assessment of the partner’s dr
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 77 and 78: Amenorrhoea does not necessarily me
Page 79 and 80: Pre-conceptual advice on drug use c
Page 81 and 82: Antenatal care Receiving good quali
Page 83 and 84: 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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