Obstetric Liaison in Drug Dependency

Abstract

This study describes the first two years of an obstetric liaison service between the Liverpool Drug Dependency Clinic and the two local maternity hospitals. The service comprised, medical officer, drug liaison midwife and a designated obstetrician at each of the hospitals. A total of 88 women were seen from whom there were 60 deliveries producing 61 babies. Only two women delivered without either service identifying their pregnancy. This compares to a previous estimated rate of 75% of drug users being undetected by the obstetric services. The amount of methadone a woman was taking did not predispose to any specific obstetric intervention. There was a higher rate of small for gestational age babies in this group but other factors may be more important than a mothers drug use. Higher levels of maternal methadone did not reduce foetal weight. There was a tendency to increase the risk of neonatal opiate withdrawal symptoms and premature labour with higher doses of methadone, although this requires further study. The multidisciplinary approach of the Liverpool Drug Dependency Clinic allowed in a majority of cases for assessments prior to delivery, so reducing the number of crisis child protection conferencing after birth. The multidisciplinary team endeavoured to establish normalisation policies for other health care workers who have contact with pregnant drug users on treatment, and in so doing, encouraged a change in the general midwifery staffs attitudes, to be more positive and accepting rather than discriminatory.We suggest that prescribing methadone within a harm reduction philosophy has produced acceptable outcomes for opiate dependent women and their babies.

Triply troubled: Criminal behaviour and mental health in a cohort of teenage pregnant substance misusers in treatment

“…Substance misuse in pregnancy is associated with high mortality rates, yet research into the nature of, and the response to, teenage pregnant drug use is unusual. We could identify only a few previous studies (Murray, 1992; Morrison et al, 1995; Coghlan et al, 1999; Day and George, 2005; Bonell et al, 2007). Our study identified a small cohort of very young girls who, by virtue of multiple psychological problems, suffer from extremely chaotic lives, with numerous risk factors for substance misuse in adolescence that continued into their pregnancy.…”

“…Unfortunately, pregnant women often under‐report substance use (Markovic et al, 2000) and are not routinely sensitively probed so it is estimated that 75% of drug users are undetected by obstetric services (Morrison et al, 1995). This limits the implementation of effective interventions early in the pregnancy (Richardson, 1999; Cook et al, 2005).…”

Policy Progress for Physician Treatment of Opiate Addiction

“…Some countries or regions rely almost exclusively on generalist physicians and community pharmacies, and others utilize mixed models where new or more complicated patients are treated in specialized clinics and moved to general practice once stabilized. A “shared care” approach has also been developed, in which patients concurrently receive prescriptions for methadone from general practitioners and psychosocial addiction services from drug treatment centers 42–44 …”