Women, Pregnancy and Substance Use Dependence Maternal and Child Health Conference 22 nd February 2013 Theresa Lynch Manager – Women’s Alcohol and Drug.

Women, Pregnancy and Substance Use Dependence

Maternal and Child Health Conference 22nd February 2013

Theresa LynchManager – Women’s Alcohol and Drug Service, The Royal Women’s Hospital

Overview of Presentation

Overview of Women’s Hospital and WADS

Demographics

Substance Use

Challenges for Women

Principles of Care / Skills

What We Can Do

Considerations for Maternal and Child Health Nurses

The Women’s Hospital

Established in 1856

157 years of leadership and innovation in women’s health

Is Australia’s largest specialist hospital dedicated to improving the health of all women, and newborn babies

Cares for women of all ages

WADS

Officially opened in 1985

Statewide - funded Dept. Health

Unique in Victoria

Provides comprehensive support from a multi-disciplinary team to reduce the harms associated with alcohol and drug use in pregnancy

Specialised Obstetric & Paediatric care

Midwifery and Social Work Assessment and Support

Drug and Alcohol Counselling

Inpatient Methadone Program

Dietary & Pharmaceutical Advice

Psychiatric Consultant

What We Do

What We Do

Service Sector Development and Support

Training and Education

Research

Secondary Consultation

Duty System between 9 – 5

24 hour obstetric on-call service

Demographics

Ages range from 18 – 43

Mean age at delivery 28

Mean gestation at delivery 37

Nursery Admissions 48%

Total requiring NAS scoring 70%

84% past psychiatric disorder

60% more than one past psychiatric disorder

Demographics

88% unemployed

58% secondary education

48% have a forensic history

50% past experiences with Child Protection

24% having past infant removals(Audit 2007 – 2009 Mental Health Team

of 50 mother-infant pairs)

Substance Use

(2013 Audit 15 mothers 2011-2012)

Child Protection

(2013 Audit 15 mothers 2011-2012)

Challenges for Women

Multiple experiences of childhood and adolescent trauma

Poverty

Sexual Abuse

Violent Relationships

Mental Illness

Homelessness

Poly-drug Use

“Children with significant histories of abuse, particular

sexual abuse, will suffer psychologically, emotionally,

socially and as adults they are over represented in the drug

and alcohol sector”

(Breckenridge & Salter, 2010, p. 7)

In order to cope with traumatic experiences children adapt

through a range of behaviours which allow them to escape

and deal with the pain, confusion and memories of

their sexual assault experiences.

(Levenkron, 2007)

Pregnancy provides us with a rare opportunity to engage with women who often do not access health services

Principles of Care

Building a strong therapeutic relationship

Engagement

Multidisciplinary approach

Focus on strengths

Collaborative decision making

Ongoing assessment

Respectful response to all women

Strong emphasis on baby

What we can do

Acknowledge mother’s aspirations, requirements and competencies

Acknowledge her fears

Ensure she is surrounded by service providers who are working collaboratively

Ensure she is well understood

Pharmacotherapy

Relapse prevention

Find out where they are at, be curious

Demonstrate empathy, respect and genuineness

Be non-judgemental

Don’t be overwhelmed / or afraid

Be mindful of her limited resources and support

Some questions

How confident am I in recognising, and managing women with substance use dependence?

Are you able to help and advise women about their drug use?

Maternal and Child Health Support

Critical

All women with complex drug use require enhanced maternal and child health support

Assessment of withdrawal in baby

Assessment of risk and protective factors

Referrals

WADS 8345 3931

Fax 8345 2996

[email protected]

Obstetric Consultations

8345 3931(business hours)

8345 2000 (after hours)

References

Breckenridge, J., Salter, M. & Shaw, E. (2010) Use and Abuse. Understanding the intersections of childhood abuse, alcohol and drug use and mental health. The University of New South Wales & Adults Surviving Child Abuse.

Levenkron, S. (2007) Stolen Tomorrows. Understanding and Treating Women’s Childhood Sexual Abuse. W. W. Norton, New York.

Sinason, V. (2002) Attachment, Trauma and Multiplicity. Routledge, London.