Blackpool consistently tops a list of the highest drug mortalities in the UK, and has the highest number of alcohol related deaths and suicides in England. A significant number of pregnancies in Blackpool are complicated by substance misuse. As a result, the authors have developed a structured programme at Blackpool Victoria Hospital (BVH), to ensure the best outcome.
Women with substance misuse issues have high-risk pregnancies and can be at risk of exclusion from traditional antenatal care. In our unit, all women have one-to-one care with the specialist midwife and lead consultant. They have input from anaesthetists to discuss issues regarding intravenous access and analgesia in labour.
The key aims are reducing harm, by carrying out risk assessment, and stabilising drug use, via substitute prescribing or inpatient detoxification. An individualised plan of care is made for all women.
Normal delivery is emphasised where possible and all midwives are made aware of individual care plans. Mother and baby are cared for together unless there are medical or legal reasons to do otherwise. Long acting reversible contraception (LARC) is discussed and Implanon implants are fitted to all appropriate women prior to discharge.
This programme is still in its infancy at BVH but already results have indicated improved engagement with the services. There has been better compliance; reduction in caesarean section rates; reduced neonatal care admissions, and increased uptake of LARC. The emphasis is on maintaining normality and ensuring normal aspects remain the focus of care, not the substance misuse.
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