Alcohol, Drugs and Pregnancy Do Our Attitudes Influence Our Practice

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Alcohol, Drugs and PregnancyDo Our Attitudes
Influence Our Practice?

• Chris Weaver
• Specialist Midwife Substance Misuse
• Mobile [phone]
• Email chris.weaver_at_new-tr.wales.nhs.uk

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Social Exclusion Substance Misuse 1

• What is it like to be on the wrong side, on the
  outside, to be excluded?
• Social exclusion is characterised by
  unemployment, low educational achievement, poor
  housing, family strains, general break down of
  community, high crime levels a high fear of
  crime.
• Social exclusion represents a joined up package
  of problems therefore requires a genuinely
  joined up solution
• Social exclusion substance misuse - tends to be
  substance misuse which is characterised by
  dependence

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Social Exclusion Substance Misuse 2

• Drug dependence can affect anyone regardless of
  race, class, gender or age
• Dependence fills voids - psychological, social,
  emotional, spiritual temporal. For example
  unemployment creates a void heroin dependence
  fills it
• Exceptions to this rule - drug dependence amongst
  the rich famous
• Drug use may well be an equal opportunity
  recruiter. Drug dependence is highly
  discriminatory
• The majority of tomorrows problematic substance
  misusers will come from those areas of highest
  social exclusion

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Influences on Womens Substance UseIndividual
influences

• Depression anxiety
• Feelings of powerlessness
• Individual responses to drugs
• Individual attitudes, beliefs values
• Self esteem
• Body image sexual difficulties
• Dealing with pain illness

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Societal environmental influences

• The marketing of drugs to women
• Prescribing practices
• Discrimination
• Interpersonal community influences
• Drinking drug use by peers partners
• Difficult family environment
• Stressful life events
• Social isolation
• Experiences of physical sexual abuse as a child
  or adult

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Substance Misuse Pregnancy 1

• Barriers to service utilisation
• Fear of negative judgemental attitudes from
  professionals/society
• Guilt shame - for having a problem, for not
  being perfect, fear of not being a good mother
• Fear of childcare proceedings
• Lack of trust in confidentiality procedures
• Inaccessible inappropriate service
• Fear of baby being taken automatically to SCBU
• Chaotic lifestyle

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Substance Misuse Pregnancy 2

• Attitudes
• Pregnancy can act as a catalyst for change
  modification of behaviour
• Disclosure
• Consistent, correct non conflicting advice
• Personal beliefs attitudes must not influence
  information given
• Changing Childbirth (DOH,1993) - woman should be
  the focus of maternity care
• Informed choice

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Substance Misuse Pregnancy 3

• Can attitudes be changed? How do we achieve
  this?
• Education
• Policies, protocols guidelines
• Inter-agency collaborative working
• Support
• Empowerment service user views

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Substance Misuse Pregnancy 4

• Substance Misuse Possible Effects on Maternal
  Health
• Heroin
• Opiate substitutes - methadone, subutex
• Cocaine/ crack cocaine
• Amphetamines
• Benzodiazepines
• Cannabis/tobacco
• Alcohol

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Substance Misuse in Pregnancy 5

• Substance Misuse Possible Social Needs
• Social isolation/exclusion
• Homelessness
• Domestic Abuse
• Mental health problems
• Teenage pregnancy
• Poor life skills
• Poor parenting skills

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How can we give women the opportunity to change?

• By increasing her understanding of the
  risks/dangers of misuse
• By encouraging her partner to engage with
  treatment services
• By giving her support being non judgemental
• By teaching alternate ways to deal with her
  feelings that do not involve alcohol other
  drugs
• By building an awareness of how her living
  situation is affecting her use of alcohol other
  drugs how she can take steps to alleviate or
  change the situation
• By being there .

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Womens Views

• Shes been a really good help, you know making
  sure Ive been treated properly by other hospital
  people. Sometimes when you are on heroin they
  think that you dont care.
• It helps to have a professional who understood
  our position was prepared to be vocal in our
  defence ,when other professionals behaved less
  than professional with their stereotypical
  attitude. The service credited us for the people
  we are
• You go to these antenatal things, all the other
  mums are there, quite healthy then theres you,
  and you do stand out, you feel like you do they
  treat you differently some of them, and it
  shouldnt be like that really.

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Thank You

• Chris Weaver
• Specialist Midwife Substance Misuse
• Mobile [phone]
• Email chris.weaver_at_new-tr.wales.nhs.uk