Originally published by Druglink, July 11, 2011.
Pregnant drug users not only have to battle stigma and moral panic, but also prejudice and confusion among those professionals charged with supporting them. Joe Lepper reports on a new guide which aims to improve help for mothers.
“Some of the nurses looked down at me. The way they spoke to me made me feel really uncomfortable,” says 28 year Angela of her experience of being pregnant and dependent on methadone. Angela, who is still on a methadone programme and gave birth to her daughter last year, says hospital staff also had little regard for her confidentiality.
“When I had visitors they would mention that I had an appointment to do with the methadone programme right in front of them. I thought that was really out of order, a real breach of my privacy,” she adds.
According to Anne Whittaker, nurse facilitator for NHS Lothian and author of The Essential Guide to Problem Substance Use During Pregnancy, Angela’s experience is still far too common for pregnant women with drug and alcohol issues.
She said: “There is still a prejudice among some professionals, that is why a running theme in the guide is the importance of not making judgments.
“For example, if a midwife asks a pregnant woman with drug issues about drug and alcohol use it is important to make clear all pregnant woman are asked these questions and they are not being singled out,” she says.
Another theme of the book is the importance of empathising with “the complexity of their lives.”
Whittaker says: “They are pregnant, they have an addiction, there may be social care involvement with other children. They may also have housing problems, money problems. There is a lot to deal that those supporting them need to understand.”
This complex range of issues pregnant women with drug and alcohol problems face means successful support needs to involve professionals across health, social care, drug and addiction services as well as other areas such as housing, says Whittaker.
While most areas in the UK offer this multi-agency support to pregnant women with drug and alcohol issues, schemes vary in scope, specialist involvement, investment and organisation.
In Edinburgh NHS Lothian and Edinburgh City Council run the Prepare service for high-risk pregnant drug users in the city.
Whereas in Manchester such support is offered through a specialist midwifery service that also helps pregnant women with mental health problems and Aids/HIV.
Whittaker explains there is a lack of research as to which model works well and no two areas offer exactly the same service.
Fay Macrory, the consultant midwife who manages Manchester’s service, says the management and infrastructure of services is less important than ensuring they offer non- judgmental and honest support.
Macrory says: “When I say honest I mean we don’t mince our words. We tell it how it is around issues such as safeguarding children and explain the consequences of not protecting children or looking after themselves.”
She agrees with Whittaker that empathising with patients’ often chaotic lives is also vital. She says: “You have to understand what is going through their head. They may have a probation meeting, need to pick up methadone. If you want them to go to an antenatal class as well you have to be aware of all these pressures and stress its importance.
“One of the biggest compliments I had was one of the women saying, that I was ‘alright’ because I was ‘like one of them but without the drug problems’,” Macrory adds.
Understanding many patients’ often deep rooted “antagonism against social workers” often from their own experiences as a child, is also important, she says.
Such fear had meant women in the past would not engage with support services and present themselves to midwife services late into their pregnancy.
“Some are very antagonistic about social workers and may be worried their baby will be taken away. You need to understand and address those fears. They cannot be ignored if you want them to engage in the service,” says Macrory.
While Angela encountered prejudice from some hospital staff, she praised the understanding approach of NHS Greater Glasgow and Clyde’s Special Needs in Pregnancy (SNIPS) service, the specialist programme that supported her during her pregnancy.
“They were really good, I felt supported and they took me to appointments as well,” she says of the service, which includes social workers, midwives, nurses and addiction workers from the charity Addaction.
Whittaker concedes though that barriers remain in providing such specialist support.
Lack of resources across the public sector is one. “I would be very surprised if there was any area where most women in this situation were seen by a specialist drug and alcohol service midwife. They will most likely be seen by a general midwife,” says Whittaker.
She concedes it would be unrealistic to expect increasingly tight public sector coffers to fund a dramatic increase the number of specialist midwives.
“This is why the book is aimed at generalists as well across health, social care and addiction services. It is they who will be offering the support,” says Whittaker.
Another barrier is access to training for generalists to cover the complex array of issues facing pregnant women with addiction issues.
Whittaker says: “There are some very good courses out but there is no national standard. Areas are doing it themselves. In some cases specialist midwives are running courses aimed at generalists. There is a demand, but it can be hard for people in already demanding jobs to get time off to attend courses.”
Across the UK Scotland has the most coherent approach to training. The Scottish government has commissioned the University of Glasgow and Drugscope to run Scottish Training on Drugs and Alcohol (STRADA), the country’s drug and alcohol training body.
The body, which does not have an equivalent in other UK regions, covers issues such as challenging prejudice and clinical problems associated with drug use.
Such clinical issues, which are also covered in Whittaker’s book, include neo-natal abstinence, where babies are born addicted to the drug the mother is using and go through a period of withdrawal.
Inserting a module covering drug and alcohol addiction, pregnancy and family life in all entry- level courses across health, addiction services, education and social care would help improve professionals’ knowledge markedly, says STRADA head Joy Barlow.
Already STRADA runs a University of Glasgow elective course for trainee teachers on supporting families that have drug and alcohol issues. “But this is just one course, it’s not compulsory and its for just one profession,” Barlow adds.
The public sector’s “silo mentality” is another barrier to effectively supporting pregnant women with drug and alcohol issues, says Barlow.
She welcomes the focus of Whittaker’s book on the importance of partnerships involving all professionals involved with pregnant drug and alcohol users. “Currently teams of social workers and drug advisers still work in their silos even if they work in the same building. That needs to be addressed,” says Barlow.
Another focus of Whittaker’s book Barlow welcomes is the importance of involving fathers.
Barlow says: “Pregnancy is about relationships, between couples, between parents and a child and with professionals. The father is part of this.”
For Whittaker she is convinced where support services for pregnant drug users are coordinated, work well in partnership and offer a stigma-free service then “women find it invaluable” and a help in tackling their addiction.
Angela agrees: “Before I had my daughter I was topping up on the methadone with heroin, I don’t do that anymore. I have to think about my daughter, put her first and make sure I’m there for her.”