Guidelines for Multi-Agency Assessment of Pregnant Women and their Babies in Cases where there is Substance Misuse
Contents
- Introduction and Criteria
- Identification and Response
- Referrals
- Multi-Agency Assessment
- Assessment for Treatment
- Child Protection Concerns / Planning Meetings
- Care of Baby
1. Introduction
These guidelines are intended to:
- Encourage pregnant women who misuse drugs and/or alcohol to seek early antenatal care and, where appropriate treatment;
- Normalise antenatal and postnatal care as much as possible whilst recognising the social and medical problems associated with substance misuse and providing appropriate services to address these;
- Establish an action plan to meet the needs of the pregnant woman, her baby and any other children within the family;
- Ensure communication exists between all professionals so that advice to the woman is consistent, and that any concerns about drug/alcohol misuse and Safeguarding or Child Protection issues are identified and dealt with appropriately.
N.B. In this document Substance Misuse is defined as:
The use of illicit drugs, prescription medication or alcohol, the consumption of which is either dependent or associated with having harmful effects on the individual and / or the community.
2. Identification and Response
All women will be asked at booking for maternity services about their use of prescribed and non prescribed drugs (both legal and illicit), tobacco and alcohol as part of routine enquiries about medical conditions.
All women disclosing substance misuse will be referred to the Specialist Midwife Drug & Alcohol use who works at Barnsley Hospital NHS Trust.
Pregnant women must be given accurate and honest information about the risks of their drug/alcohol use on themselves and their unborn baby. This needs to be done sensitively, and in a non-judgmental way, so that the woman is not deterred from seeking help, even if she continues to use substances.
The expectant mother is likely to need re-assurance that drug and/or alcohol misuse in itself will not result in professionals assuming the expected baby is at risk of abuse or neglect. However, the woman should be informed that there will be discussion amongst professionals to establish whether there are any concerns for the well- being of the unborn baby.
An Early Help Assessment must be completed with all pregnant service users who disclose any drug or alcohol misuse. (All forms and guidance regarding the Early Help Assessment are available from the Barnsley Council website).
It is important that the woman is helped to make choices about how to manage the situation. On no account should a pregnant woman be told to stop using drugs or alcohol immediately, until seen by drug treatment services. Many women want to stop completely in order to prevent suffering to the baby but this may be undesirable for both clinical and social reasons. Too rapid a withdrawal may harm the baby or contribute to a miscarriage or premature labour even where the mother feels reasonably well.
In addition, the social and emotional stresses caused by pregnancy make it an unrealistic time to achieve complete withdrawal, particularly if a partner is still using and there is risk of relapse, which could be harmful to the baby.
3. Referrals
When a pregnant woman presents at a drug treatment agency, she should be referred to the Specialist Midwife (Drug & Alcohol Use)/local maternity services and encouraged to take up early antenatal care. The Specialist Midwife should be informed of the woman's pregnancy to ensure follow up should the woman not take up ante-natal care.
When a woman attends for antenatal care (with GP or maternity service), she should, with her consent, be referred to a specialist drug/alcohol agency (Phoenix Futures) and the Specialist Midwife.
Pregnant women are given priority with Drug Services and bypass waiting lists in order to receive priority assessment and treatment where required. If the woman's partner also uses drugs/alcohol s/he should be encouraged to access treatment as this increases the chances that the woman will be able to stabilise her drug/alcohol use during pregnancy. Where possible the partner should be fast tracked into treatment.
All agencies that become aware of a pregnant woman who is misusing drugs and/or alcohol or whose partner/significant other(s) are misusing drugs and/or alcohol have a responsibility to refer her to the Specialist Midwife, Ward 11, Barnsley Hospital.
4. Multi-Agency Assessment
Where a pregnant woman, or a parent, misuses drugs and/or alcohol, family life may be affected even though the children may not necessarily be suffering Significant Harm. Any assessment needs to consider the impact of the drug/alcohol misuse and associated activities on the unborn child and whether there are any resultant concerns for the child's welfare or safety. In addition the assessment must consider the ability of the substance using parent to provide appropriate levels of care for the child following delivery. It is also important to assess any protective factors that are present. The assessment should be informed by multi-agency collaboration and enable an appropriate support package to be provided for the mother and unborn child/family.
5. Assessment for Treatment
Pregnant women will be fast tracked into specialist services for assessment and treatment where required. Assessment can be undertaken via the Specialist Midwife/Drug Treatment Agencies.
Appropriate treatment will depend on past history, amount and types of drug/alcohol used, as well as the woman's motivation and current situation. If engaged in treatment a care navigator and drug worker will instigate a package of care/care plan with the woman and aim to reduce the risks to the parent, unborn child and any other family members.
Substitute medication (e.g. Methadone) can be prescribed to stabilise the drug use of women who use opiates and opioids. Research has shown that this enables better contact between the woman and services during pregnancy and therefore provides greater stability for the foetus.
Women who are difficult/refuse to engage are provided with full information and monitored through the general maternity services with an ongoing aim to engage them in drug services.
It is good practice to obtain consent from the woman to inform the Health Visitor for the woman of the assessments and service involvements in the ante-natal period.
6. Child Protection Concerns / Planning Meetings
Where there are significant problems that may lead to concerns about the care of the expected baby, a referral to Children's Social Care must be made (see Making a Referral to Social Care Procedure).
In some cases, where assessments indicate that the unborn baby is likely to be at risk of Significant Harm, the decision to undertake a pre-birth Initial Child Protection Conference will be taken. This conference will decide whether the child needs to be subject to a Child Protection Plan at birth (see Child Protection Plans Procedure).
Where a pre-birth Initial Child Protection Conference is convened, a Child and Young Person's Assessment will be undertaken looking at the impact on the child of the parent's substance misuse. It is expected that Core Group meetings will take place monthly, attended by the parent/s and all the professionals involved in the care of the parents and children. A Review Child Protection Conference will follow this not later than three months after the Initial Conference to assess how the parents are managing to care for the baby, and whether there is a continuing need for a Child Protection Plan or other formal support mechanisms. Thereafter a Review Child Protection Conference will be held not later than every six months whilst the child remains subject to a Child Protection Plan.
In cases where the woman's substance misuse is not known until the baby is born. An Early Help Assessment is still needed and must undertaken prior to discharge from hospital.
It also needs to be noted that a Child Protection Conference may be convened, not because of concerns relating to the pregnant woman, but due to concerns relating to her partner.
All pregnant women who were identified at booking as using substances and not already referred to Children's Social Care, will have a pre delivery meeting at 28 weeks in pregnancy to discuss the mother's and baby's needs. This will be arranged by the Specialist Midwife and will involve all professionals currently identified as working with the woman or likely to be in the near future e.g. health visitor.
The purpose of this meeting is to review to Children's Social Care is required.
The pre-delivery meeting should identify any likely problems and all the services that the parents may need to care for the new baby. The meeting is also an opportunity for information exchange for all involved; an action plan to be put in place (if needed) or referral to Children's Social Care may be identified.
A post delivery meeting will also be arranged to ensure that the community based care of the woman and her baby is well co-ordinated prior to their discharge. The post delivery meeting will normally include midwife, health visitor, drugs worker, and social worker
All plans – pre-birth and discharge should be clear and have details of all the workers involved and their respective roles, and any actions for the parent/s to achieve.
7. Care of Baby
Babies may experience withdrawal symptoms after birth. While there is considerable experience of withdrawal of babies from opiates, less is known about the effects of other drugs and substances.
The incidence and severity of neonatal withdrawal symptoms do not always correlate with the mother's level of substance use. It is not possible to predict how bad an individual baby's withdrawal symptoms will be from the mother's pattern of substance use.
Therefore it will be explained to all pregnant ladies that they should expect to remain in hospital for 5 to 7 days post delivery in order for baby to be monitored/treated for neonatal withdrawal symptoms.
Further Information
Keeping Children Safe in Education: Statutory Guidance for Schools and Colleges