PREVENTING FUTURE PROBLEMS SCOTTISH DRUGS FORUM 28th November 2005 Intervention at Birth Mary Hepburn Princess Royal Maternity Glasgow

DRUG USERS AS PARENTS Drug use is not incompatible with adequate parenting Women should be helped to have pregnancies if and/or when they choose Services should help women protect and control their fertility

DRUG USE AND PREGNANCY Medical outcomes Increased maternal mortality and morbidity Increased perinatal mortality and morbidity Increased ill health in adulthood

DRUG USE AND PREGNANCY Social outcomes Parenting difficulties Separation of mother and baby Child protection issues

DRUG USE AND FERTILITY Drug use can reduce fertility directly and indirectly Menstruation is not an indicator of fertility Risk of sexually transmitted infections Methadone increases fertility Stabilisation of lifestyle increases fertility Women who do not want to become pregnant need effective contraception

PLANNING OF PREGNANCIES Stability of drug use Stability of lifestyle Diet Cytology screening Infection screening Folic acid supplementation Postnatal contraception

DRUGS AND CONTRACEPTION Effective Usable Safe Long acting Reversible

DRUG USE AND INFECTION BBV screening STI screening Cytology screening Immunisation vs HBV / HAV Follow up of babies

SERVICE DESIGN AND DELIVERY Management: address poverty as a whole Reproductive healthcare: an integral part of all drug treatment services Maternity care: multidisciplinary, embedded in maternity services Service design: continuity of reproductive healthcare Service delivery: accessible by any route including self referral Follow up: family support in the community