Substance Misuse in Pregnancy - NHS Lothian

More documents

Recommendations

Info

Care in the community After 72 hours stay on the postnatal ward, babies with mild to moderate symptoms can be discharged home where they can be cared for by their parents with community midwifery and health visiting support. The midwife will offer advice and support on a daily basis and will arrange for readmission to hospital if the baby’s symptoms worsen. As part of the infant’s ongoing care, parents should be advised to continue using the NAS assessment score chart and supportive therapy measures until the baby’s symptoms have resolved. Parents should be advised to record all feeds (amounts taken and times) so that the midwife and health visitor can monitor the baby’s daily calorie intake. The community midwife and health visitor will also weigh the baby to ensure weight gain is satisfactory. If the baby’s symptoms get significantly worse at home (i.e. sleeps less than 1 hour/ cries 1 hour after feeds/ weight loss after day 7) then it is better to admit the baby to hospital earlier rather than later. If the baby has been home for less than a week, or is less than 10 days old they may be admitted to the Neonatal Unit at RIE, Little France or Special Care Baby Unit (SCBU) at St John’s Hospital, West Lothian. If the baby is more than 10 days old they are likely to be admitted to Sick Children’s Hospital (RHSC) or the Children’s Ward at St John’s Hospital. Community staff should discuss admission with the Neonatal Unit / SCBU first. Care in hospital Parents need to know that admission to the Neonatal Unit at Little France or the SCBU at St John’s Hospital is necessary if their baby develops severe withdrawal symptoms. Babies with severe symptoms often require ‘tube’ feeding, pharmacological (drug) treatment and 24-hour care and supervision from specialist paediatric medical and nursing staff. The aim of treatment is to: � reduce irritability and motor instability � establish an appropriate feed/sleep/wake cycle � maintain a normal body temperature, and � ensure adequate weight gain. Substance Misuse in Pregnancy 49
Babies with severe symptoms usually stay in the unit for about 10-14 days, but sometimes for much longer. Mothers are encouraged to ‘board’ (rooms permitting) in the hospital whilst their baby is in the unit (particularly if they are breastfeeding) or at least have daily contact to continue the bonding process. In Lothian, pharmacological management is decided by the attending physician but normally includes the use of one or more of the following drugs: oral morphine, diazepam, clonazepam, clonidine, phenobarbitone, chlorpromazine or chloral hydrate. The best drug appears to be morphine if the main drug used by the mother has been an opioid. Where other drugs (e.g. benzodiazepines) have been used alone or in combination, drug therapy needs to be individually tailored towards a longer or biphasic pattern of withdrawal (Shaw 1999). Care is taken not to sedate the baby and to wean them off medication as soon as possible. Babies can be discharged home as soon as they are well enough to be cared for by their parents. Substance Misuse in Pregnancy 50
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 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 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: � Swaddling of the baby will help
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
Page 85 and 86: usually possible to be quite reassu
Page 87 and 88: 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
Page 93 and 94: These documents contain important i
Page 95 and 96: Intrapartum care (labour and childb
Page 97 and 98: There may be placental insufficienc
Page 99 and 100: states she is taking the baby home
Page 103 and 104: Women who are Hepatitis B positive
Page 107 and 108: Postnatal care The care of a pregna
Page 109 and 110:
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
Page 117 and 118:
Finally, it is important to remembe
Page 119 and 120:
Services List Services providing ma
Page 121 and 122:
with a drug dependency who are on s
Page 123 and 124:
Drug services in Lothian Most speci
Page 125 and 126:
Local drug services � Locality Cl
Page 127 and 128:
Alcohol services in Lothian Most sp
Page 129 and 130:
Other services in Lothian A variety
Page 131 and 132:
Introduction Key points Setting Fur
Page 133 and 134:
� Royal College of Obstetricians
Page 135 and 136:
General � Scottish Executive webs
Page 137 and 138:
References Abel EL, (1998) ‘Fetal
Page 139 and 140:
NICE (National Institute for Clinic
Page 141 and 142:
Introduction Key points Setting the
Page 143 and 144:
Drug/Alcohol related problem: refer
Page 145 and 146:
Substance Misuse in Pregnancy 124
Page 147 and 148:
INDEX Alcohol, 37-38, 52-56, 84 scr
Page 149 and 150:
Introduction Key Appendices points
Page 151 and 152:
Substance Misuse in Pregnancy 128
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:
Page 163 and 164:
Page 165 and 166:
Introduction Appendix 4: Model Care
Page 167 and 168:
Introduction Appendix 5: Key Consen
Page 169 and 170:
Introduction Key points Setting App
Page 171 and 172:
Page 173 and 174:
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 and 196:
This leaflet provides you with info
Page 197 and 198:
Parents are encouraged to keep a cl
Page 199:
Breastfeeding Breastfeeding and and
show all

Substance Misuse in Pregnancy - NHS Lothian

Create successful ePaper yourself

Delete template?

Save as template?