Social effects of drug use

The social impact of alcohol and other drug (AOD) use during pregnancy is as important as the physical impact, as its produces consequences for women’s health. Due to socioeconomic deprivation, WUD need multidisciplinary care embedded in maternity services.

The use of AOD, often associated with a chaotic lifestyle, can cause or exacerbate effects of socio-economic deprivation on health and may negatively influence engagement with services. Parental duties and tasks are often compromised by intoxication, but also by the lifestyle associated with AOD use. Caring for a sick baby is demanding for any mother and especially stressful for women with additional issues such as drug use.

The interlinked relationship between medical and social factors demonstrates why pregnant WUD need multidisciplinary care, with joint collaboration and input from both health and social services. It is a fact that WUD have high risk pregnancies and poorer pregnancy outcomes. As for all women with high risk pregnancies – (e.g. those with diabetes), maternity care should be provided by an obstetrically-led multi-disciplinary team. Services and support should include resources for care for the baby after birth, information on infant feeding options, nutritional counselling and support, information on vaccines and other preventive measures, post-partum examination of the mother, HIV treatment, care and support for both mother and child when needed and referral for prophylaxis and treatment of HIV-related conditions and other commonly associated conditions (e.g., TB), provision of support to WUD living with violence.

Drug using women should receive analgesia during birth, with increased doses of opiates as necessary; newborns should be accommodated at the postnatal ward with their mothers, unless their medical conditions recommend admission to special care. Drug use is not necessarily a contraindication for breastfeeding and should in general be encouraged. Breastfeeding mothers should be advised that using a high dose of drugs such as cocaine or benzos is incompatible with successful breastfeeding, and that babies should not be exposed to these drugs. After birth, maternal drug use should not be considered as a child protection issue per se. If child protection issues are identified, they need to be addressed separately. Planning of future pregnancies should be discussed during pregnancy and appropriate contraception needs to be commenced before postnatal discharge.