Substance Exposed
Pregnant Women and their
Babies
Dixie L. Morgese, BA, CAP, ICADC
Premises
Every woman wants a healthy baby.
 Every woman deserves a healthy baby.
 Pregnancy is a finite period that can be
the determinant for a child’s future.
 Pre-pregnancy is the BEST time to address
alcohol and drug use!
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Learning Objectives
Identify three screening techniques for use with
pregnant women who may be using alcohol or
other drugs.
 Gain an increased understanding of various
classes of drugs and their effects on pregnant
women, the developing fetus, and the newborn
baby.
 Identify five systems of care and their roles and
responsibilities related to substance exposed
pregnant women and their babies.
 Learn a five point approach to effective
multidisciplinary staffing and coordination.
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Terms
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SEN – Substance Exposed Newborn
CDN – Chemically Dependent Newborn
NAS – Neonatal Abstinence Syndrome
NAS* - Neonatal Abstinence Scoring
FASD – Fetal Alcohol Spectrum Disorder
FAS – Fetal Alcohol Syndrome
WIS – Women’s Intervention Specialist
FIS – Family Intervention Specialist
ATOD – Alcohol, Tobacco and Other Drugs
CNS – Central Nervous System
Terms
Hyperreflexia – Overactive reflexes –
response to stimuli
 Overstimulated – “overwhelmed” by
stimulus
 Philtrum – vertical groove on the median
line of the upper lip.
 Feeding intolerance – inability to suck,
swallow or retain feedings.
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Terms
Drug Endangered Infant/Child – a wide
range of risk associated with exposure to
alcohol and other drugs.
 Marchman Act – petition that supports
legal remedy regarding evaluation and
intervention.
 State Regulation – ability to adapt to
external stimulation.
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CNS Substances
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Children of mothers who used drugs:
– Stimulants – risk of preterm labor and
abruption
– Depressants – alcohol most damaging
– Opiates – increasing numbers of cases
– Marijuana
– Hallucinogens
– Tobacco*
- low birth
SIDS for other drugs is
Varying
responses, particularly
duringweight,
infancy. Prognosis
better than with FAS depending on term of pregnancy and environment.
Screening is IMPORTANT!
Find an approach that works for you.
 Be non judgmental
 Make it a routine part of care and
conversation.
 Know how to respond
 Be positive
 Follow up with other systems of care
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The 5 A’s Framework
“5 A’s”
Ask about alcohol, tobacco or other drug
use
 Advise to quit – unless opiates are
involved. If the woman is opiate
dependent, gain consent and coordinate
with health care providers.
 Assess willingness to quit
 Assist with support and referral
 Arrange follow-up
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Instruments Used for Screening
5
P’s and 4 P’s Plus
 CAGE AID
 T-ACE
When Should You Screen?
Screening should be a routine part of care.
 Look for physical and environmental
indicators. (fingers, arms, eyes,
paraphernalia, clothing, etc.)
 Review life management issues. (personal
hygiene, behavioral incidences, avoidance,
etc.)
 Use your senses.
 Follow your instincts.
 Intervene and Support
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5 P’s
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Parents - Did any of your parents have a
problem with alcohol or other drug use?
Peers - Do any of your friends have a problem
with alcohol or other drug use?
Partner - Does your partner have a problem
with alcohol or other drug use?
Past – Have you used alcohol or drugs in the
past?
Present - In the past month, have you drunk
any alcohol or used other drugs?
CAGE-AID
Have you ever felt you ought to cut down on
your drinking or drug use?
 Have people annoyed you by criticizing your
drinking or drug use?
 Have you felt bad or guilty about your drinking
or drug use?
 Have you ever had a drink or used drugs first
thing in the morning to steady your nerves or to
get rid of a hangover (eye-opener)?
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CAGE Source: Ewing 1984.
CAGE-AID Source. Reprinted with permission from the Wisconsin Medial Journal Brown,
R.L. and Rounds, LA Conjoint screening questionnaires for alcohol and drug abuse. Wisconsin Medical Journal 94: 135-140, 1995.
The T-ACE Questionnaire
T Tolerance: How many drinks does it take to
make you feel high?
 A Have people annoyed you by criticizing your
drinking?
 C Have you ever felt you ought to cut down
on your drinking?
 E Eye-opener: Have you ever had a drink first
thing in the morning to steady your nerves or
get rid of a hangover?
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The T-ACE is considered to be positive with a score of 2 or more. Affirmative answers to the A, C, and E questions
are each scored 1 point. A reply of more than two drinks to the T question is scored 2 points (Sokol et al. 1989).
How Do You Start the
Conversation?
Be non-judgmental and build rapport.
 Keep it Simple.
 Use observable strengths.
 When the door opens – be straightforward.
 Know your limitations.
 Know your resources.
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What Next?
Know your limitations and disclose them
 Negotiate Consent for Release.
 Develop a “short term contract.”
 Be aware of timing and environment.
(conflict at home, day of the week, other
children, etc.)
 Seek supervision and coordination.
 Consider resources and barriers.
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Barriers
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Dependence
Language/Culture – paradigm to a strength
Fear of system/outcomes
Partner – control or violence issues
Treatment access/residential availability
Family system/relationships and other children
Stressors
Depression
Economic Limitations
Systems of Care
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Medical – CHD’s, CMS, hospitals, physicians,
midwives
Treatment Centers – SMA, Haven House,
DMTC – WIS, TOPWA other
Early Steps – screening of children
Child Welfare (DCF and Community Based
Care) – legal, investigative, case management,
wrap around services – use PNA
Healthy Start – care coordination and linkage
to additional resources.
Other Possible Systems
Legal – drug court, probation, child
support enforcement.
 Workforce Development – economic
self sufficiency for mother and partner.
 Child Care/ELC – respite, structure,
stability.
 Others – Homeless Services, Domestic
Violence support, HIV/TOPWA, Mental
Health, Healthy Families, Insurance.
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Five Point Approach
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Identify key players – including and centering
on the patient.
Unify referral processes - identify the point
person/entity.
Coordinate consent – Healthy Start screening
form can support collaboration until further
consent is obtained.
Align policies and procedures – ensure
systems have interagency agreements which
delineate roles and responsibilities..
Utilize unified staffing forms.
Follow Up
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Identify additional staffing activities – establish dates,
times.
Key coordinator – typically case management or care
coordination.
Ensure client completed referrals and verify subsequent
appointments.
Prior to delivery, coordinate with hospital/birthing center.
Provide documentation for pediatric follow up.
Identify who will provide ongoing education to the
family.
Establish family planning and interconceptional care
plan.
Points to Remember
SEN babies are at elevated risk for SUIDS
– ensure family has safe sleeping
environment.
 Mothers at elevated risk for PPD or relapse
– identify support system.
 Caregivers need to know how to handle
SEN babies – ensure special instruction is
provided and ongoing.
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Questions?
Let’s work together to keep them ALL
safe, healthy, and happy!
Thank You!
To learn more about the Infant Mental Health Chapter of Volusia and Flagler
Counties, visit us on our website at:
www.healthystartfv.org