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As many health care professions are aware there is a growing epidemic in the United States of pregnant woman who are using drugs during their pregnancy.  In rural areas of the United States, there may be no doctors to care for these mothers which can mean NO Prenatal Care.  

I wondered what is happing with your OB-GYN's and what are the Policies to care for drug using mothers in your area.  I would like ideas.  Are you in a rural area? If so, are your obstetricians caring for these patients or are they sending them practice dismissal letters?

Are you an area being referred these patients from more rural areas and do you think with the epidemic, that the OBs in the rural areas should learn management skills and pediatricians (who are very capable of caring for NAS - Neonatal Abstinence Syndrome- babies) should dismiss these mothers from care or instead provide compassionate care.  

I am interested in the opinions of hospital social workers, public health departments, OB-GYNs, Pedi's, FP's and anyone else involved in the care and management of these mothers.  

I am also interested in thoughts concerning Substance Abuse Reporting during Pregnancy.  States vary widely on their approach to this issue.  I have the re-affirmed policy statements for these issues from ACOG and will put in a summation of the statements, below as we continue our Discussions. 

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COMMITTEE OPINION: Opioid Abuse, Dependence, and Addiction in Pregn...

Obstet Gynecol. 2012 May;119(5):1070-6. doi: 10.1097/AOG.0b013e318256496e.

ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy.

Abstract

Opioid use in pregnancy is not uncommon, and the use of illicit opioids during pregnancy is associated with an increased risk of adverse outcomes. The current standard of care for pregnant women with opioid dependence is referral for opioid-assisted therapy with methadone, but emerging evidence suggests that buprenorphine also should be considered. Medically supervised tapered doses of opioids during pregnancy often result in relapse to former use. Abrupt discontinuation of opioids in an opioid-dependent pregnant woman can result in preterm labor, fetal distress, or fetal demise. During the intrapartum and postpartum period, special considerations are needed for women who are opioid dependent to ensure appropriate pain management, to prevent postpartum relapse and a risk of overdose, and to ensure adequate contraception to prevent unintended pregnancies. Patient stabilization with opioid-assisted therapy is compatible with breastfeeding. Neonatal abstinence syndrome is an expected and treatable condition that follows prenatal exposure to opioid agonists.    [PubMed - indexed for MEDLINE]

Committee On Health Care for Underserved Women and the American Society of Addiction Medicine.
Original May 2012 -- Reaffirmed 2014.  
LINK TO THE COMPLETE ACOG COMMITTEE OPINION

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  • CommitteeOpinionASAM2012

State Policies on Substance Use During Pregnancy as of July 1, 2014

From: GUTTMACHER INSTITUTE STATE POLICIES IN BRIEF 

The above guidelines give the requirements of each state regarding policies on Substance use during pregnancy.

Substance Abuse Reporting and Pregnancy: The Role of the Obstetrician-Gynecologist (ACOG Policy Statement)

Number 473, January 2011

(Reaffirmed 2014)


Committee on Health Care for Underserved Women


Abstract: Drug enforcement policies that deter women from seeking prenatal care are contrary to the welfare of the mother and fetus. Incarceration and the threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse. Obstetrician–gynecologists should be aware of the reporting requirements related to alcohol and drug abuse within their states. They are encouraged to work with state legislators to retract legislation that punishes women for substance abuse during pregnancy. "

 


PDF Format

ACOG Policy Statement on the Non-Medical Use of Prescription Drugs During Pregnancy

Committee on Health Care for Underserved Women

Number 538, October 2012

(Reaffirmed 2014)

 

Below is the Link to the Complete ACOG Committee Statement: 

Non-Medical Use of Prescription Drugs During Pregnancy

The 4 P's of Screening Mothers for Drug use During Pregnancy

Parents: Did any of your parents have a problem with alcohol or other drug use?

Partner: Does your partner have a problem with alcohol or drug use?

Past: In the past, have you had difficulties in your life due to alcohol or other drugs, including prescription medications?

Present: In the past month have you drunk any alcohol or used other drugs?

Scoring: Any “yes” should trigger further questions.

Ewing H. A practical guide to intervention in health and social services with pregnant and postpartum addicts and alcoholics: theoretical framework, brief screening tool, key interview questions, and strategies for referral to recovery resources. Martinez (CA): The Born Free Project, Contra Costa County Department of Health Services; 1990.

Prenatal and Postpartum Care of Women with Substance Use Disorders

Sarah Gorman, BA, MD (2014)

KEYWORDS

Prenatal care Substance abuse disorder Postpartum care Opioid dependence Opioid replacement therapy Pregnancy Opioid addiction

KEY POINTS

  •  Prenatal care providers should screen all patients for substance abuse disorders in preg- nancy using a validated screening tool.
  •  Women identified as having a substance abuse disorder in pregnancy should be offered coordinated multidisciplinary care.
  •  Opioid replacement therapy improves pregnancy outcomes for women with opioid dependence and is not a contraindication to breastfeeding.
  •  Women with substance abuse disorders should be evaluated and treated for concurrent psychiatric disorders.
  •  A respectful, nonjudgmental, and flexible approach by clinicians encourages ongoing pa- tient participation in prenatal care. 

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