Substance Misuse in Pregnancy - NHS Lothian

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pharmacy. This information should be written clearly on the antenatal liaison form (substance misuse). The woman should remember to take any supply of medication into hospital with her, as it will not be replaced if it has already been dispensed in the community. On discharge, the hospital will notify the prescribing doctor when the next dose of medication is due to be dispensed from the community. Pain relief during childbirth Women who use drugs may be fearful of labour and childbirth and worry that they will not get adequate pain relief. It is very important that adequate pain relief is given and the midwife establishes a good rapport with the woman, offering reassurance and support when required. It is a good idea to discuss pain relief options in the antenatal period so that the woman feels confident that she will be well cared for and treated like any other woman in labour. Prescribed medication should be dispensed as normal during labour. Substitution treatment with methadone or dihydrocodeine does not provide pain relief. Opioid receptors may be saturated so higher doses or more frequent injections of diamorphine are likely to be needed (Sparey & Wilkinshaw 1999). There is usually a low threshold for an epidural anaesthesia and many drug dependent women opt for this pain management approach. Caesarean section is no more likely than in the normal population and having a history of drug misuse should not be considered a contraindication to having a PCA pump (patient controlled analgesia pump) following caesarean section (Siney 1999). Post delivery pain relief should be the same as for every other woman, although higher doses may be required. Complications of childbirth In women with a history of injecting drug use, venous access may be poor and antenatal referral to an anaesthetist may be required. Where labour is straightforward, no intravenous line is required. However, if it appears that there might be complications, it is sometimes better to establish an intravenous line electively shortly after admission, rather than be faced with the task in an emergency situation (Johnstone 1998). Substance Misuse in Pregnancy 82
There may be placental insufficiency in pregnancies of drug-using women, leading to an increased risk of intrapartum hypoxia, fetal distress and meconium staining (Department of Health 1999). Meconium aspiration is common and is associated with fetal distress secondary to periods of intra-uterine drug withdrawal. Some babies will be growth restricted so there should be careful surveillance during labour. Maternity staff should follow hospital guidelines for obstetric and neonate management for meconium staining. High dose benzodiazepine use in the mother can result in the newborn showing signs of intoxication at birth that include: poor sucking, poor reflexes, hypotonia (low muscle tone), hypothermia (low body temperature), a feeble cry and low APGAR scores. Severely affected neonates may require vigorous resuscitation at birth because of respiratory depression. Women who are anxious about childbirth should be warned not to ‘self medicate’ with non-prescribed benzodiazepines (e.g. Valium®) before they admit themselves for delivery. Please note: Labour ward staff must not use naloxone (an opiate antagonist) to reverse opioid induced respiratory depression in neonates as this will induce an abrupt opiate withdrawal crisis. Use supportive measures or ventilation if necessary. Postpartum care in hospital After delivery, the labour ward midwife should liaise with staff in the postnatal ward to ensure continuity of care. The key midwife in the community should also be informed of the delivery. This is particularly important if the woman has delivered pre-term. Maternity staff providing intrapartum care should complete the pregnancy outcome form (substance misuse) (see appendix 9). All known drug dependent women are asked to stay in hospital for three days (72 hours) following the birth of their baby. This is because the baby needs to be observed for signs and symptoms of Neonatal Abstinence Syndrome (NAS), which normally develop within this time period (see section on NAS for further information, page 43). Substance Misuse in Pregnancy 83
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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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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
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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
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Page 95: Intrapartum care (labour and childb
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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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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