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Women, Pregnancy and Substance Use Dependence Maternal and Child Health Conference 22 nd February 2013 Theresa Lynch Manager – Women’s Alcohol and Drug Service, The Royal Women’s Hospital. Overview of Presentation. Overview of Women’s Hospital and WADS Demographics Substance Use

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Overview of Presentation

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  1. Women, Pregnancy and Substance Use DependenceMaternal and Child Health Conference 22nd February 2013Theresa LynchManager – Women’s Alcohol and Drug Service, The Royal Women’s Hospital

  2. Overview of Presentation • Overview of Women’s Hospital and WADS • Demographics • Substance Use • Challenges for Women • Principles of Care / Skills • What We Can Do • Considerations for Maternal and Child Health Nurses

  3. The Women’s Hospital • Established in 1856 • 157 years of leadership and innovation in women’s health • Is Australia’s largest specialist hospital dedicated to improving the health of all women, and newborn babies • Cares for women of all ages

  4. WADS • Officially opened in 1985 • Statewide - funded Dept. Health • Unique in Victoria • Provides comprehensive support from a multi-disciplinary team to reduce the harms associated with alcohol and drug use in pregnancy

  5. What We Do • Specialised Obstetric & Paediatric care • Midwifery and Social Work Assessment and Support • Drug and Alcohol Counselling • Inpatient Methadone Program • Dietary & Pharmaceutical Advice • Psychiatric Consultant

  6. What We Do • Service Sector Development and Support • Training and Education • Research • Secondary Consultation • Duty System between 9 – 5 • 24 hour obstetric on-call service

  7. Demographics • Ages range from 18 – 43 • Mean age at delivery 28 • Mean gestation at delivery 37 • Nursery Admissions 48% • Total requiring NAS scoring 70% • 84% past psychiatric disorder • 60% more than one past psychiatric disorder

  8. Demographics • 88% unemployed • 58% secondary education • 48% have a forensic history • 50% past experiences with Child Protection • 24% having past infant removals • (Audit 2007 – 2009 Mental Health Team of 50 mother-infant pairs)

  9. Substance Use • (2013 Audit 15 mothers 2011-2012)

  10. Child Protection • (2013 Audit 15 mothers 2011-2012)

  11. Challenges for Women • Multiple experiences of childhood and adolescent trauma • Poverty • Sexual Abuse • Violent Relationships • Mental Illness • Homelessness • Poly-drug Use

  12. “Children with significant histories of abuse, particular sexual abuse, will suffer psychologically, emotionally, socially and as adults they are over represented in the drug and alcohol sector” • (Breckenridge & Salter, 2010, p. 7)

  13. In order to cope with traumatic experiences children adapt through a range of behaviours which allow them to escape and deal with the pain, confusion and memories of their sexual assault experiences. • (Levenkron, 2007)

  14. Pregnancy provides us with a rare opportunity to engage with women who often do not access health services

  15. Principles of Care • Building a strong therapeutic relationship • Engagement • Multidisciplinary approach • Focus on strengths • Collaborative decision making • Ongoing assessment • Respectful response to all women • Strong emphasis on baby

  16. What we can do • Acknowledge mother’s aspirations, requirements and competencies • Acknowledge her fears • Ensure she is surrounded by service providers who are working collaboratively • Ensure she is well understood • Pharmacotherapy • Relapse prevention

  17. Find out where they are at, be curious • Demonstrate empathy, respect and genuineness • Be non-judgemental • Don’t be overwhelmed / or afraid • Be mindful of her limited resources and support

  18. Some questions • How confident am I in recognising, and managing women with substance use dependence? • Are you able to help and advise women about their drug use?

  19. Maternal and Child Health Support • Critical • All women with complex drug use require enhanced maternal and child health support • Assessment of withdrawal in baby • Assessment of risk and protective factors

  20. Referrals • WADS 8345 3931 • Fax 8345 2996 • wads@thewomens.org.au • Obstetric Consultations • 8345 3931(business hours) • 8345 2000 (after hours)

  21. References • Breckenridge, J., Salter, M. & Shaw, E. (2010) Use and Abuse. Understanding the intersections of childhood abuse, alcohol and drug use and mental health. The University of New South Wales & Adults Surviving Child Abuse. • Levenkron, S. (2007) Stolen Tomorrows. Understanding and Treating Women’s Childhood Sexual Abuse. W. W. Norton, New York. • Sinason, V. (2002) Attachment, Trauma and Multiplicity. Routledge, London.

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