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Drug withdrawal during pregnancy
A hospital stay will mean experiencing a state of withdrawal for some of your clients. While this is sometimes planned for (for example, if the birth happens on schedule) there are many instances in which clients are admitted unexpectedly and are thus not entirely prepared for withdrawal (for example, if the baby arrives early or if the client needs to stay overnight for some other medical reason etc.)
Pregnancy can prompt young mothers to abruptly cease their substance use. Some use pregnancy as a motivating reason to change behaviours, others might make the decision for financial reasons or due to fear of Child Protection’s involvement. Whatever the reason, hastily ceasing use can be dangerous and often clients won’t be sufficiently linked in with services that can offer support, information, guidance and monitoring of the client’s health and wellbeing (such as detox services or a hospital’s substance-use focused antenatal team). It’s common for workers to enter a client’s life at this stage and so swift connection with a variety of services will be required (while being mindful of not overwhelming the client).
Honesty and transparency
Clients fearful of Child Protection’s involvement will often withhold information around their substance use or deny their substance use altogether. While it’s important to emphasise the need for honesty and transparency throughout pregnancy, you cannot force clients to open up and so you will need to simply work with the information at hand. Together you can still discuss harm reduction and safety considerations and explore support services. It often takes time to earn a client’s trust and alleviate her fears, which comes from a concern that information offered to you, the worker, will be shared with Child Protection.
In order to build a solid and viable care plan or withdrawal plan, a pregnant client needs to be encouraged to be honest, open and transparent with her medical care team. Be sure to emphasise the importance of honesty when it comes to conversations between your client, her GP and other medical staff as withholding information could be detrimental to the client’s own health and safety as well as the health and safety of her unborn child.
Pharmacotherapy withdrawal programs
As a young parents’ worker, you should become familiar with medical services specialising in antenatal care for mothers using substances. Some hospitals have a team within the midwifery clinic that deals exclusively with substance use during pregnancy. Where possible, establish relationships with these teams to smooth the process of linking clients in and the sharing of information thereafter; and with your client, be sure to normalise access to such services. These specialist teams ensure clients have access to the most relevant information applicable to their pregnancy and post-birth period. Linking clients in with these services also ensures that gaps in your medical knowledge and expertise are covered by highly trained medical professionals who can guide clients on difficult subjects such as withdrawing during pregnancy and exploring alternative options to substances and other medications etc.
Hospital pharmacotherapy clinics are an excellent source of information and support. Linking pregnant, substance dependent clients with a specialist pharmacotherapy team is essential so that the client’s withdrawal can be carefully monitored and supported with other medications where needed. Where clients are yet to be connected with such a service, it’s still advisable for you, the worker, to make contact in order to ask questions and gather information that will help you prepare your client.
If a client is already undergoing pharmacotherapy treatment, it’s important to make contact with their prescribing doctor. With the client’s permission, their doctor will be able to offer further information about the client’s situation and potentially link the client in with a specialist antenatal service.
Belated pregnancy discoveries
Sometimes a young person using substances won’t realise she is pregnant until late in her pregnancy (sometimes up to six months). This belated realisation can come as a shock and leave the client feeling as though she has very few choices. Her introduction to the hospital and other necessary services will unfold speedily as opposed to the more steadily paced introduction afforded to those engaging earlier in their pregnancy. The experience can be overwhelming and so to minimise a client’s stress or confusion, accompanying her to appointments is advisable. Not only can you offer comfort and support but your presence will also position you as the go-between relied upon to interpret, break down and translate the information received (next steps, medical systems, medical risks, pregnancy jargon, prescriptions, test results etc.) and feed it back to the client in relatable and easily absorbed language.
For clients progressing through withdrawal, it’s important to discuss relapse prevention strategies. How has the client approached withdrawal so far? What is working and what is not? What has worked in the past? How is withdrawal affecting her ability to cope (a question particularly relevant to young mothers who have other children)? Discuss the client’s mental health and how withdrawal is affecting those around her (her partner, children, parents etc.) Those struggling to cope might benefit from respite, whether formally or informally arranged. Your guidance will also involve ensuring the client is connected with other support services that can help ease the stress and difficulty of withdrawal and the post-withdrawal period.
Young parents considering detox will likely benefit from guidance and support regarding how to discuss the situation with their children. While it can be a delicate balance to strike, it’s best for parents to be as honest as possible with their children. In saying that, caution clients not to frighten their children (however unintentionally) by emphasising the illness aspect of their situation; for example, telling young children that ‘mummy is very sick and needs to go away for a while’ risks scaring them to a degree that is possibly avoidable.
Some detox services allow clients to bring their children with them; however, this comes with its own host of considerations regarding what the child will be exposed to and whether or not it’s the best temporary care option for the child.