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2 The Unborn Child
2.1 The unborn child of a substance misusing parent needs to be protected as soon as the mother's pregnancy is confirmed. Maternal drug or alcohol use carries significant risk, which can affect foetal development. Drug injecting during pregnancy may also result in the transmission of HIV and viral hepatitis to the baby.
At present we do not have figures showing the number of children born in Scotland to
drug-using mothers. Work is underway to identify how this information could be collected. NHSScotland is commissioning an audit of practices and opinion relating to recording of data of substance misuse in pregnancy.
A woman's motivation for getting help for her substance misuse problems is often increased because of pregnancy but she can also have fears about contacting services, including ante-natal services, in case her child or existing children are taken away. The issue for services is how to address the fear barrier and capitalise on the opportunity afforded by the pregnancy.
Staff providing ante-natal care should, as set out in "Getting our Priorities Right", notify agencies when a woman with a history of substance misuse becomes pregnant. If the woman does not agree to referral to an addiction or specialist maternity service, ante-natal staff should consider whether the potential risk is significant enough to override the need for the woman's consent to referral.
The interests of the child and the mother are inextricably linked. Maternity services and those who may be helping the parent to tackle their substance misuse must work closely together.
Key issues in relation to the unborn child Best practice means: - identifying as early as possible in pregnancy the possible spectrum of risk to, and needs of, both mother and baby, and alerting services before the birth;
- developing effective care plans and regular and realistic review of the plans;
- offering a range of multi-agency/multi-professional approaches to care, that are non-judgemental; and
- ensuring that no pregnant woman, misusing substances, arrives at a maternity unit to give birth without her situation being known and without support being available for her and her child.
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2.2 Key Action Points
The Executive will undertake the following action to promote best practice in relation to the unborn child. We will:
- work with NHS Boards and local authorities to examine how the availability of contraceptives and family planning advice for substance misusers can be improved within the context of implementing the Executive's 2005 report "Respect and Responsibility" - by autumn 2006;
- make sure that ADATs and Child Protection Committees have in place local protocols for sharing information and working with families affected by substance misuse as recommended by "Getting our Priorities Right", including sharing information to identify pregnant substance misusers - ongoing;
- help healthcare workers to identify alcohol problems and domestic abuse in pregnancy by encouraging the use of the unified "Handheld Record for Pregnant Women", launched in 2005 - ongoing;
- ensure that the "Framework for Maternity Services", published by the Scottish Executive in 2003, is fully implemented - ongoing;
- fund and evaluate a project in Glasgow looking at ways of improving how holistic maternity services for drug-using women, addiction services, and services for children and families can be delivered more effectively to those who face complex problems - between April 2006-March 2008;
- review current advice on drinking during pregnancy to ensure it is consistent and continue to raise awareness of the risks as part of national and local communications campaigns - by September 2006;
- publish a study on neo-natal abstinence syndrome ( NAS) exploring the impact of a community-based, structured assessment aimed at identifying babies with continued or late-onset NAS - summer 2006; and
- publish research commissioned from NHS Health Scotland, looking into how the recording of data during the antenatal period might be improved - in 2006.
2.3 Further action required
As part of the continuing implementation of "Hidden Harm - Next Steps" more work needs to be done to: train midwives and health visitors so that they can support substance misusing pregnant women and be confident about signposting them to specialist services; and highlight the consequences of alcohol use in pregnancy and the possibility of foetal alcohol syndrome ( FAS).
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