Download Substance Misuse and Treatment Options in Pregnancy Helping you

Substance Misuse and
Treatment Options in
Pregnancy
Helping you to care for
yourself and your baby
An Information Leaflet
April 2011
Every Patient Matters
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Introduction
Welcome to Stepping Hill Hospital Women’s Unit.
Pregnant women, and sometimes their partners, who use drugs may
have special needs that we hope to meet.
We feel that it is important that you know how the substances and
medication that you use may affect your baby. This will enable you to
make an informed decision on how best to protect both yourself and
your baby.
We want to offer you support and encouragement during your
pregnancy, birth and as you become a parent.
This leaflet aims to:
 Provide you with an introduction to the support services available
to help you.
 Help you to understand the possible effect of the substances and
medication that you take on both you and your baby.
 Look at treatment options, if you are not currently in treatment.
 Suggest different ways to reduce any possible adverse effects of
your drug use on both you and your baby.
 Help you to enjoy your pregnancy: get the right balance between
rest and gentle exercise, eat plenty of fresh foods and a wellbalanced diet.
Substance misuse - effects on the unborn and newborn
baby and suggested treatment options
Stockport Community Drug Team (CDT), Community Alcohol Team
(CAT), Mosaic and Maternity Services are here to support you
throughout your pregnancy in labour and following the birth of your
baby. Mosaic provides a holistic service relative to drug and alcohol
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misuse. This includes assessment, support and treatment to women and
their partners aged 25years and under. Mosaic also provides support to
your family members. The CDT and the CAT provides these services to
women over 25 years of age and their families.
We suggest stopping/reducing the most harmful drugs first. It is
therefore recommended that drugs should be stopped/reduced in the
following order:
1. Alcohol
Although alcohol is a legal drug, there is no safe level of alcohol
intake during pregnancy. New Government guidelines advise
pregnant women not to drink any alcohol. Drinking alcohol during
pregnancy can cause birth defects, affect your baby’s growth, brain
development and may cause long term behavioural problems.
We suggest that you stop drinking as soon as possible. If
you are alcohol dependent, to avoid withdrawals, alcohol should be
reduced slowly under supervision with the Community Alcohol
Team (CAT). If appropriate, and with your informed consent, an
alcohol detox can be arranged at any stage of your pregnancy on
Maternity Ward Mat 2. You can self refer yourself to the
Community Alcohol Team (Tel 249-4070) or speak to your midwife
about referral to CAT.
Please keep a record of your substance misuse and medication
taken so the Community Alcohol Team and Maternity Services can
best plan for you and your baby.
2. Nicotine/Cannabis
It is advisable to stop smoking in pregnancy and
afterwards. There is a smoking-cessation midwife who can help,
and you can contact her via your team midwife or Antenatal Clinic.
Cannabis users can also seek help and support via the Community
Drug Team. Please keep a record of your substance misuse and
medication taken so the Community Alcohol Team and Maternity
Services can best plan for you and your baby.
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3. Stimulants:
Amphetamines
(Stone, Crack, Coke)
4
(Speed,
Whizz)/Cocaine
Use of stimulants can affect your baby’s growth and can increase
the risks of miscarriage, premature birth and bleeding in
pregnancy. After birth, some babies experience mild withdrawal
symptoms i.e. irritability, unable to settle and poor feeding.
We suggest that you stop using stimulants as soon as
possible. It is safe to stop at any stage during pregnancy.
4. Benzodiazepines (Benzo’s)
Taking these can cause severe withdrawal symptoms in your baby
after birth and there is also a link with long-term behavioural
problems.
We suggest that to avoid withdrawals, Benzodiazepines
should be reduced slowly under supervision with the
Community Drug Team. If appropriate, they can also arrange
for a reduction or detox, during your pregnancy, on Ward Mat 2.
5. Opiates (Heroin, Methadone, Codeine etc)
If Opiate dependant, it is important not to stop suddenly in
pregnancy, as this can lead you to withdraw and also your unborn
baby. This can lead to miscarriage, premature labour and low birth
weight babies.
Within 2-4 days after birth, babies can show withdrawal symptoms
- Neonatal Abstinence Syndrome (NAS).
We suggest that it is important to reduce and stop illicit
heroin use and replace it with methadone, under
supervision with the Community Drug Team.
If you are injecting, we suggest that you stop injecting. To
reduce risks of blood borne virus infection/DVT/ skin infections,
needle exchanges are available to ensure all the equipment is
clean. You may also be advised to smoke instead, to reduce the
risks from injecting.
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Do not smoke any substances or cigarettes around
children, due to the harmful effects of passive smoking.
It is important to:
 Seek help in early pregnancy. You can contact a midwife
directly by phoning Stepping Hill Hospital on 0161 419 5551,
or by visiting your GP or by asking at the Community Drugs
Team (CDT) 0161 249 4000.
 Please keep a record of your substance misuse and
medication taken so the Community Drug Team and
Maternity Services can best plan for you and your baby.
 The Community Drug Team can arrange access into
treatment for you and your partner, if required.
How to access treatment
If you are using drugs and not in treatment, you can:
 Speak to your midwife, Obstetrician or GP who can refer you to the
CDT, or you can refer yourself either in person or by telephone.
 You will be given an appointment for an assessment and your
treatment needs identified. Your allocated drugs worker will then
book you a medical appointment to then start your prescribed
treatment.
 Your Drug Worker will liaise with your midwife to ensure that your
treatment is part of your antenatal care.
Working together with the CDT will ensure that you and your baby
receive the best care during pregnancy, labour and after birth. This can
mean increasing or decreasing your prescription as necessary.
Community Drug Team Opening Hours:
Monday – Wednesday 9.00 – 5.30pm
Thursday
9.00 – 6.30pm
Friday
9.00 – 4.00pm
Telephone No:
0161 249 4000
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Treatment options
 Methadone Oral Solution (Meth, Green)
Methadone oral solution is the most used treatment for opiate
dependency and is taken as a liquid 1mg/1ml. It can help you to
stabilise and reduce or stop illicit drug use. Babies may still
withdraw following birth (Neonatal Abstinence Syndrome).
 Subutex
Subutex is also used to treat opiate dependency and is taken
orally, dissolved under the tongue. As it is a newer medication, it
has been prescribed, with caution, during pregnancy. As it has an
effect of preventing opiates reaching the brain – partial blocker, it
will help to stop heroin use. Babies may still withdraw following
birth.
 Reductions and Detox
It is safer for you and your baby to be stable on a suitable dose of
medication than to experience withdrawals if not on an adequate
dose, or start using street drugs.
For some women, it is unrealistic to expect them to detox,
therefore a planned reduction and stabilisation can be arranged
either at home or as an in-patient in Stepping Hill Hospital.
Any detox must be carried out within a specialist hospital service
i.e. Drugs North West.
Any medication must be stored safely away from children.
Important reminder
Please be aware that it is a criminal offence under the misuse of drugs
act Section 8 for the trust knowingly to permit someone to use, supply
attempt to supply, produce or attempt to produce an illicit substance on
Trust premises.
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The presence or use of illicit substances on NHS premises puts staff,
pregnant women and visitors at risk of harm or prosecution. Where staff
are aware that this is the case, they must take action.
After the birth
After the birth, your baby may have some withdrawal symptoms. For this
reason, we recommend that you and your baby stay on the ward, for 5-7
days, to enable the Midwives to observe your baby. The baby will remain
on the ward with you unless there is an indication for the baby to be
admitted onto the Special Care Baby Unit i.e. premature baby.
If your baby does show signs of withdrawal, treatment can be given to
settle the baby, only if required.
Testing for hepatitis and HIV
All pregnant women, whether they have used drugs or not, are offered
Hepatitis B and HIV testing. If you or your partner has a history of
injecting drug use, you will also be offered Hepatitis C testing.
The benefits of being tested are:
 If you are Hepatitis B positive, your baby can be vaccinated after
birth, which will help prevent the baby from being infected.
 If you are Hepatitis C positive, you can be referred to a liver
specialist, for further tests and treatment options. Your baby will
also be monitored for any signs of the virus infection.
 If you are HIV positive, your obstetrician and midwives will discuss
treatment options and management for labour, delivery and follow
up for the baby, to reduce the risk of transmission of the virus to
your baby. At Stepping Hill Maternity Unit
 Hepatitis B Vaccine is given to all babies of substance
misusing women. With your consent, we will give your
baby Hepatitis B vaccine within 24 hours of birth
regardless of Hepatitis B status.
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Referrals to child and family services
You will not be automatically referred to Social Workers just because you
are in treatment. However, if there are any concerns about the wellbeing
of your baby or if you need extra support, they may be asked to help
and assess your needs.
Useful information and telephone numbers
Stockport Community Drugs Team, Tel 0161 249 4000
Stockport Community Alcohol Team, Tel 0161 249 4070
Mosaic (Stockport Young Peoples Drug and Alcohol services) (25year
olds and under), Tel 0161-480-5939.
Derbyshire Alcohol Advice service, Tel 01246204344
(Derbyshire residents only)
Alcohol Concern, Tel 020 7928 7377
www.alcoholconcern.org.uk
AA (Alcohol Anonymous), Tel 0161-236-6569
www.aa-uk.org.uk
Drinkline , Tel 0800 917 8282
Offers free and confidential information and advice
Opening Times Mon – Fri 9am -11pm. Sat –Sun 6pm -11pm
Stepping Hill Hospital Antenatal Clinic
ANC Manager, Tel 0161 419 5524
Delivery Suite and Triage (open 24 hours a day), Tel 0161 419 5551
Specialist Midwife - Eileen Maloney, Tel 0161 419 5455
Smoking Cessation Midwife - Sue Adamson, Tel 0161-419-4734
Child and Family Services Contact Centre, Tel 0845 644 4313
NHS Direct, Tel 0845 46 47
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Info Health, Tel 0161 429 7010
Frank, Tel 0800776600
Offers free and confidential advice about drugs all day, and every day
www.talktofrank.com
Families Anonymous, Tel (020) 74984680
(Operates self help groups around the country for families and friends of
people with a drug related problem.
Opening Times Mon – Fri 1-4pm)
Our smoke free policy
As per the smoke free law, smoking is not allowed by anyone anywhere
on the hospital site. For further information, please read the patient
information leaflet 'Policy on Smoke Free NHS Premises'.
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Produced by Stockport NHS Foundation Trust©
Review Date: April 2013
If you would like this leaflet in a different format, e.g. in large
print, or on audiotape, or for people with learning disabilities,
please contact PCS.
Your local contact for more information is Patient and Customer Services
at Poplar Suite, SHH, Tel: 0161 419 5678 or
www.stockport.nhs.uk
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