Women, Pregnancy and
Substance Use Dependence
Maternal and Child Health Conference 22nd February
2013
Theresa Lynch
Manager – 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
What We Do
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
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
wads@thewomens.org.au
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.