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DrugScope Conference 2011. Caring for the pregnant drug user Faye Macrory MBE. Manchester Specialist Midwifery Service. Consultant Midwife 4 Specialist Midwives Personal Assistant drug/alcohol use mental health/illness domestic violence/abuse

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DrugScope Conference 2011

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DrugScope Conference 2011

Caring for the pregnant drug user

Faye Macrory MBE

Manchester Specialist Midwifery Service

Consultant Midwife

4 Specialist Midwives

Personal Assistant

drug/alcohol use

mental health/illness

domestic violence/abuse

prostitution/sex work

criminal justice system

safeguarding/child protection

drivers for change:

  • Every Child Matters (DFES 2003, 2004)

  • Hidden Harm (ACMD 2003, 2006)

  • Think Family: improving the life chances of families at risk (2008)

  • Drugs: protecting families & communities. Action plan (2008-2011)

  • Ten Pitfalls and how to avoid them

    (NSPCC 2010)

  • Safeguarding in the 21st Century - where to now? (2010)

  • The Munro Review of Child Protection: A Systems Analysis & Interim Report: the child’s journey (2011)

  • Working together: (2010)

  • Early Intervention: the next steps (Allen 2011)

  • Saving Mothers’ Lives (CMACE 2011)

  • NICE SCiP Guideline (110)


  • Why love matters: how affection shapes a baby’s brain (Gerhardt, S. 2004)

  • Ghosts from the Nursery: tracing the roots of violence (Karr-Morse, R. & Wiley, M.S. 1997)

  • Meeting Multiple Needs: Pregnancy, Parenting and Dual Diagnosis (Macrory, F).In Rasool G.H. (ed) Nursing Care of the Dual Diagnosis Patient (2006

aims and objectives:

  • provide appropriate, accessible and family-focused services to improve health gain

  • embrace all aspects of a vulnerable and socially excluded lifestyle

  • to raise awareness of the impact of parental substance misuse on children and young people

commonly used drugs in the UK include:

  • alcohol and…………

  • cannabis (hash & marijuana)

  • benzodiazepines (e.g. diazepam, temazepam)

  • opioids (heroin, methadone, dihydrocodeine, buprenorphine)

  • hallucinogens (LSD, acid, magic mushrooms)

  • stimulants (amphetamine, cocaine, ecstasy, mephedrone & other ‘legal highs’)

  • cyclizine, ketamine,‘GHB’, amyl-nitrate, anabolic steroids, anti-depressants, anti-psychotics

  • volatile substances (gas, glue, aerosols)

  • OTC drugs – codeine /DFII8

  • encourage and enable clients to think beyond their immediate needs

  • emphasis on whole family approach – strengths and weaknesses

  • supporting families to stay together ?

  • breaking the cycle……………..

‘……….a proper understanding of our own beliefs and values is important, as our attitudes influence the work we do………..’



the challenges ahead:

  • addiction & recovery

  • relationships & dependency

  • death & dying

  • love & loss

  • mental health

  • recognizing the problems

  • barriers and obstacles to engagement

  • hostile and uncooperative families

  • disguised compliance

  • setting realistic goals

  • initiating/sustaining change

  • risk reduction/harm minimization

  • confidentiality vs sharing information

  • following the pathways

  • who to refer to ? how to ?

  • escalating concerns

  • accountability

  • ethical dilemmas

  • coping with stress and burn-out

  • personal/professional boundaries

  • supervision/support & taking care of yourself

parenting assessments:

When does an adult’s

  • drug and/or alcohol use

  • mental health/illness

  • domestic violence/ and abuse

    ………….pose a conflict of interest within a family?

  • how does parenting capacity become impaired in these circumstances?

  • what is a child’s capacity to tolerate the changed and often detrimental care they may receive?

  • when does it pose risks for the safety & well-being of the child/children?

what about the parent/carer’s:

  • ability to provide a stable and nurturing environment?

  • sense of responsibility?

  • extended family and wider context ?

  • financial/housing status?

  • commitment to maintaining the family?

  • health/emotional resources?

  • ability to communicate & work together?

  • history of violence or conflict?

what about the child’s:

  • understanding of the substance misuse?

  • exposure to traumatic incidents?

  • fears, fantasies & level of confusion?

  • is the child socially isolated? bullied? stigmatized?

  • what is the child’s total experience? what compensatory measures are used?

  • is the child the target of the parent’s paranoid projections? delusions? hallucinations?

challenges for professionals:

  • how can these risks be assessed? How can they be managed?

  • who decides when these risks become acceptable? or unacceptable?

  • what services need to be available to meet the needs of both adults and children in these circumstances?

  • how do those working in these circumstances need to be trained and supported?

  • what can be done to bridge the gulf between professionals trying to meet the needs of children & parents?

  • how can the different agencies involved ensure consistent practice & good communication between each other?

see the adult……

……and see the child

How is it possible to convince a child

of his own worth, after removing him

from a home which is said to be

unworthy, but with whom he


Maya Angelou


Contact details:

Manchester Specialist Midwifery Service

Zion Community Resource Centre

339 Stretford Road


M15 4ZY

Telephone: 0161 226 6669

Fax: 0161 226 7126

Email: [email protected]

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