1.  A 35 year old accountant, is day 2 after giving birth to a healthy girl – her first child  The baby is starting to become increasingly unsettled and irritable  A drug and alcohol history is taken and it is found that the woman normally takes 3 x 5mg diazepam daily for the last 3 years following a miscarriage  You also find out she takes between 10 and 20 panadeine tablets most days for pain from an old back injury and has done so for about 8 years. She takes no other drugs or alcohol Post natal Case Study (1) Outline

2. 1.What are the drugs the woman could be dependent on? 2.What are the key withdrawal signs for the drugs she has been using? 3.What is the D&A management for the mother 4.What is the management for the baby? Post natal Case Study (2) Questions – in small or large group(s)

3. 5. Is this a mandatory DOCS referral? 6.What information or services are available to help you deal with this situation? 7.What discharge plans should be made and what should be offered? Post natal Case Study (3) Questions – in small or large group (s)

4. 1. Diazepam & codeine 2. Diazepam – anxiety, insomnia, restlessness, irritability. Opioids - perspiration, rhinorrhoea, dilated pupils, piloerection (See Guidelines 9.2 & 9.3 Benzodiazepine & opiate withdrawal) 3. D&A management – assess all D&A use, last day of use and potential for withdrawals. Consult with D&A specialist re: medication review. Encourage breastfeeding 4. Paediatric review, breastfeeding to demand, commence 4hrly NAS scoresheet, if baby is identified as opioid withdrawing then commence regular morphine and wean according to paediatric consultant. Wrap and nurse baby to reduce irritability (Refer to: National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn. (March 2006) http://www.health.nsw.gov.au/pubs/2006/ncg_druguse.html) Post natal Case Study (4) Brief guide to answers for the questions

5. 5.More information is needed, an expert child protection worker should conduct a preliminary assessment of risk to the baby and report to DoCS if current risk is identified. For further information refer to: NSW Health Policy Directive PD2005_299. Protecting children and young people 6.Local Drug & Alcohol services & NSW D&A Specialist Advisory Service 1800 023 687 24hr, Mothersafe ( 9382 6539 or 1800 647 848) Chemical Use in Pregnancy Service (CUPS) 9332 8777 or local D&A services 7.Baby – NAS states a 7 day stay for the baby. Multidisciplinary discharge, local child and family health, Paediatric follow up. Mother – possible referral to D&A outpatient for reduction of diazepam, pain clinic referral Post natal Case Study (4) Brief guide to answers for the questions