1. Women, Pregnancy and Substance Use Dependence Maternal and Child Health Conference 22 nd February 2013 Theresa Lynch Manager – Women’s Alcohol and Drug Service, The Royal Women’s Hospital

2. 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

3. 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

4. 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

5. 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

6. Service Sector Development and Support Training and Education Research Secondary Consultation Duty System between 9 – 5 24 hour obstetric on-call service

7. 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

8. 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)

9. Substance Use (2013 Audit 15 mothers 2011-2012)

10. Child Protection (2013 Audit 15 mothers 2011-2012)

11. Challenges for Women Multiple experiences of childhood and adolescent trauma Poverty Sexual Abuse Violent Relationships Mental Illness Homelessness Poly-drug Use

12. “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)

13. 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)

14. Pregnancy provides us with a rare opportunity to engage with women who often do not access health services

15. 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

16. 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

17. 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

18. 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?

19. 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

20. Referrals WADS 8345 3931 Fax 8345 2996 wads@thewomens.org.au Obstetric Consultations 8345 3931(business hours) 8345 2000 (after hours)

21. 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.