Substance Misuse in Pregnancy - NHS Lothian

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Health care staff can refer to the Scottish Executive document ‘Responding to Domestic Abuse: Guidelines for Health Care Workers in NHS Scotland’ (March 2003) for further guidance. All professionals can obtain free copies of the Scottish Executive booklet ‘Domestic Abuse: There is no excuse’ (Tele. 0131 244 3995). Neonate at risk of Neonatal Abstinence Syndrome (NAS) It is important to discuss at an early stage with all drug dependent women the possibility of Neonatal Abstinence Syndrome (NAS). She needs to know that NAS is usually easily managed but the baby will need her support, understanding and patience. Having a baby who develops severe withdrawal symptoms can be very distressing for parents, but if properly looked after the baby will make a full recovery and will come to no shortterm developmental harm (Johnstone 1998). In Lothian, a parent information leaflet called ‘Caring for a baby with drug withdrawal symptoms’ is available (see appendix 12). This leaflet should be given to all drug dependent women and their partners at around 32 weeks gestation. They should be advised to read the leaflet and discuss their birth plan and care of their baby with the midwife. For more detailed information see section on NAS, page 43. Child care risk Occasionally, a risk assessment will identify concerns about the ability of the woman (or her partner) to look after their (currently unborn) child. If this is the case, then it is important to address these concerns with the woman at an early stage. All professionals in contact with pregnant women have a responsibility to act if they believe that the baby’s safety or welfare will be at significant risk of harm. A pro-active and early intervention approach is more likely to result in a positive outcome for both mother and baby. Professionals should make themselves familiar with: � Edinburgh and the Lothian’s ‘Child Protection Guidelines’ (Nov 2002), � ‘Getting Our Priorities Right: Good Practice Guidance for Working with Children and Families affected by Substance Misuse’ (Scottish Executive 2003), and � ‘Hidden Harm: Responding to the needs of children of problem drug users’ (ACMD report 2003). Substance Misuse in Pregnancy 79
These documents contain important information for professionals, including: � The guiding principles of child protection � The legal framework on child protection � Professional roles and responsibilities in relation to protecting the welfare of children � Guidance on information sharing and confidentiality � The signs and symptoms of physical abuse, neglect, non organic failure to thrive, emotional abuse and sexual abuse � The impact of parental problem drug use on infants and children � The referral process for dealing with child care concerns and child protection issues � A checklist of information to be collated concerning substance misuse and its impact on parenting � The practicalities of protecting and supporting the children of problem drug users � A helpful contact list of professionals who have expertise in child protection within Lothian For more detailed guidance on dealing with child care concerns see section ‘Assessing and Managing Child Care Risk during Pregnancy’, page 95. Substance Misuse in Pregnancy 80
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Substance Substance misuse misuse i
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This pack has been approved by Loth
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Page Drugs and their effects on the
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Appendices ........................
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Introduction Welcome to the ‘Subs
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Please note: 1. The terminology use
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Introduction Key points Setting the
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Pre-conceptual care � Agencies in
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Substance Misuse in Pregnancy 14
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Setting the scene The extent of the
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Organisational difficulties Profess
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• Financial problems (including d
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The important role of partners need
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ecognises that a woman’s needs ar
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Guidelines on good practice This se
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An assessment of the partner’s dr
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Care management Some women with sub
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Introduction Information and guidel
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anxiety related problems and can in
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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
Page 75 and 76: Introduction Key points Setting the
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: for the women and can make attendan
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
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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
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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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