Women, Pregnancy and Substance Use DependenceMaternal 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

DemographicsSubstance UseChallenges for WomenPrinciples of Care / SkillsWhat We Can DoConsiderations for Maternal and

Child Health Nurses

The Women’s Hospital

Established in 1856157 years of leadership and

innovation in women’s healthIs 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 1985Statewide - funded Dept. HealthUnique in VictoriaProvides 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 CounsellingInpatient Methadone ProgramDietary & Pharmaceutical AdvicePsychiatric Consultant

What We Do

What We Do

Service Sector Development and Support

Training and EducationResearchSecondary Consultation

Duty System between 9 – 524 hour obstetric on-call service

Demographics

Ages range from 18 – 43Mean age at delivery 28Mean gestation at delivery 37Nursery Admissions 48%Total requiring NAS scoring 70%84% past psychiatric disorder60% more than one past psychiatric

disorder

Demographics

88% unemployed58% secondary education48% have a forensic history50% past experiences with Child

Protection24% 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

PovertySexual AbuseViolent RelationshipsMental IllnessHomelessnessPoly-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

EngagementMultidisciplinary approachFocus on strengthsCollaborative decision makingOngoing assessmentRespectful response to all womenStrong 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 understoodPharmacotherapyRelapse prevention

Find out where they are at, be curious

Demonstrate empathy, respect and genuineness

Be non-judgemental Don’t be overwhelmed / or afraidBe 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 SupportCritical

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

Assessment of withdrawal in babyAssessment of risk and protective

factors

Referrals

WADS 8345 3931Fax 8345 2996

wads@thewomens.org.au

Obstetric Consultations8345 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.