1. Substance Misuse in Pregnancy Angela Geraghty - Specialist Midwife Tel: (Office) 0116 258 5990 (Mobile) 07966 558286 (Fax) 0116 258 7262

2. ACCESS & AWARENESS Women need to be able to access the services Increase awareness of services Take care into the community Assertive Outreach – do not wait for them to come to us!

3. Drug/Alcohol misusers are known not to access general health services until late pregnancy (Drug misuse and dependence 2007) Thus increases risk to both Mother and Baby. Drug treatment programmes can enable better outcomes during pregnancy, childbirth and infant development. Regardless of continuing illicit drug or alcohol use. By opportunistic care and health promotion during engagement.

4. There is a reduced window of opportunity to engage these women and therefore it is important to take the care to them in order to maintain their involvement. The Specialist Midwife is a key person in linking all services to provide support, advice and care for both mother and baby

5. Multi-Disciplinary Approach Involvement by all agencies is vital. Offering support with Financial issues Psychological issues Social issues Domestic issues. Comprehensive, direct and easy referral process is vital for continuity of care Availability of a self referral process

6. Clinic Development Specialist Clinic – Alternate Tuesdays pm involving Cons, CDT, SW, Specialist Midwife and other co-opted members as required. Midwifery Led Clinics: Paget House Cameron Stastny Criminal Justice Integration Team, Nelson Street

7. New Guidelines & Protocols New Guidelines on caring for this client group New Referral process to Specialist Midwife for clients identified by CMW at booking appt. Clear protocol for care and identification of client needs & referral to specialist clinic. Clients engaged in care can receive shared care between CMW and Specialist Midwife/Clinic Clients difficult to engage will be caseloaded by the Specialist Midwife.

8. Further Development of Services Training for staff in substance misuse Development of a screening tool for early identification of vulnerable women to enable them early support and access to services. Comprehensive multi-disciplinary care plans to ensure a seamless service

9. References Drug Misuse and dependence – UK guidelines on clinical management. DoH 2007 Drugs: protecting families and communities – The 2008 drug strategy. HM Government 2009 Getting Our Priorities Right. Scottish Executive. 2003 Hidden Harm. Responding to the needs of children of problem drug users. Home Office 2003 The Children's Act 1989. HMSO Antenatal Care. Routine care for healthy pregnant women. National Institute of Clinical Excellence. 2003 Working Together to Safeguard Children. DoH 1999 Medications in mother's milk. T Hale, Pharmasoft publishing 2004 RCOG green top guidance, statement number 5 – alcohol consumption and the outcomes of pregnancy, March 2006 Substance Misuse in Pregnancy, A resource book for Professionals. Drugscope 2005

10. Street Names Benzo’s Brown/Smack Snow/White Bubbles/Meow Uppers/Speed Blow/Skunk Tranquilisers Heroin Cocaine Mephedrone/MCAT Amphetamines Cannabis