Multidisciplinary antenatal care for opiate-using women: Child-care issues.

INTRODUCTION AND AIMS: The fact that particular parents suffer afflictions limiting their ability to care does not mean that they should automatically be deemed unsuitable parents. Prompted by neonatal team concerns about child-care issues, a local multidisciplinary group was set up to care for substance-abusing pregnant women in our region. DESIGN AND METHODS: This project was conducted in order to review the records of all the women who had been discussed at our management planning meetings over the past 5 years. Our assessment tool records were reviewed and analysed using spss. RESULTS: A total of 233 women were assessed. The majority of patients booked before 20 weeks (62%) and 96 women (41%) attended over 80% of their antenatal appointments. There was little change in substance use during the course of pregnancy. Overall, at delivery, 196 of the 233 women (84%) used methadone and 89(38%) used heroin. There was no correlation between usage and foster care of the baby (methadone: chi(2) = 0.5, P = 0.8 NS) (heroin: chi(2) = 3.1, P = 0.08 NS). There was an absolute correlation between social services involvement and foster care (chi(2) = 2.33, P < 0.0001). Adherence with planned antenatal appointments significantly increased the likelihood of a child being discharged with his mother (chi(2) = 6.7, P = 0.009). DISCUSSION AND CONCLUSIONS: The majority of newborns were discharged home with their mothers directly with the most significant factor in placing a child in foster care being prior involvement of social services. However, many of these families will continue to need support during the children's early years.

A survey of postnatal contraception in opiate-using women.

OBJECTIVE: To document the contraceptive choices and continuation rates for different contraceptives in a group of pregnant women who use opiates. METHODS: A prospective study set in a large city in the north of England that looked at 40 pregnant women who used opiates in the index pregnancy. The study involved reviewing the records from the patients' general practitioners with information on the continuation rates of the chosen method of contraception and any related problems. RESULTS: The women given Depo-Provera (n = 14) did not continue the method after the first injection. Those given implants (n = 20) had a 95% continuation rate at a mean follow-up of over 11 months. CONCLUSIONS: Implants had a good continuation rate when used for postnatal contraception in women who used opiates in pregnancy. Depo-Provera may not be a suitable choice since all the women who chose this contraceptive method failed to continue with it.