1. Level 3 Safeguarding Training for GP’s 2013: Pregnancy & Substance Misuse Nicola Nelson Specialist Midwife 07786 250 915

2. The local picture: April 2012 – March 2013  149 notifications received  Methadone 16 (+ 5 previously treated with; completed programme)  Heroin 15 (+13 hx now treated with methadone)  Crack cocaine 20 (+ 10 hx)  Alcohol 58 (+ 9 hx)  Mephadrone 1  Ketamine 3  Subutex 1  Remainder: cannabis, XTC, benzodiazepines, cocaine, LSD, codeine

3. Neonatal outcomes  Total number of births to women known to SAAM in 2012 (financial year) = 68 women gave birth / 70 babies born @ HUH  Total opiate exposed = 7  NAS (admitted to NNU) = 3  Stillbirths = 2

4. Safeguarding  37 referred to Children’s Social Care  Babies born subject to CP plans = 15  Babies removed from mothers care = 2

5. Common challenges in safeguarding  Multiagency communication  Indentifying / engaging the male partner / father of baby  Maternal engagement

6. The SAAM MW  Care co-ordination (Egroups etc)  Case load the most chaotic / vulnerable  30/40 review  Care planning  Liaison with drug treatment provider  Discharge planning

7. Common challenges in involving GP  GP’s don’t know of Specialist Midwife service  GP’s not aware can refer direct to Specialist Midwife  Problems communicating the urgency of a situation to surgery staff  Involvement in Egroup  Representation @ ICPC

8. Best Practice: a case History Tiffany Turner is a 37 year old Caucasian woman, G1 P0. She has a history of heroin use (smoked) and is in receipt of 48 mls methadone daily (prescribed by her GP) at the time of booking. Tiffany engages well with her GP for methadone scripting. She is currently experiencing some emotional problems due to relationship difficulties with her partner (father of the baby) and her GP is arranging counselling for this. Tiffany is employed as a care worker in a residential home for people with learning difficulties and works night shifts.

9. Time Line  16/08/12 GP referral to Maternity Services @ 8/40. Indicates hx substance misuse and current methadone.  23/0812 referral reviewed by SAAM Midwife & PHMW.  20/09/12 pregnancy booking appointment with PHMW, client advises she has smoked heroin x2 since pregnant. Referred to CSC.  18/10/12 telephone call to client by SAAM Midwife to introduce self and service. Advised re methadone management. Appointment scheduled > 20/40 USS. Egroup commenced

10. Time Line  20/11/12: home visit by SAAM Midwife. CSC have referred to LADO. Next SAAM appt @ 30/40. SAU referral made.  00/12/12Professionals meeting @ GP surgery: HV, PHMW, Psychiatric Cons SAU, GP, SAAM Midwife, SW, community Psychologist  10/01/13: 30/40 review with SAAM Midwife @ ANC  16/01/13: Professionals meeting @ GP surgery: HV, PHMW, Psychiatric Cons SAU, GP, SAAM Midwife, SW, community Psychologist. CSC case closed no further action.  22/01/13: Intrapartum care plan uploaded onto EPR

11. Time Line  29/03/13: SVD, live male infant, 9/10/10, 3160g  03/04/13: mixed feeding, NAS: transferred to NNU

12. Positive outcomes Good communications enabled MA Team to assess and work with risk appropriately. Risk was ‘managed’ rather than eliminated. Concerns may otherwise have been responded to differently; could have resulted in un- necessary CP process. Baby safeguarded appropriately, family supported appropriately.

13. Further Reading  All London Child Protection procedures. 4 th Edition. 2010. London Safeguarding Children Board  Signs of Safety. Turnell A & Edwards S. 1999. Russell House Publishing, London.  Pregnancy and complex social factors. 2010. NICE guideline 110  Hidden Harm. (2003) Home Office.