Substance Abuse During Pregnancy Essay

Substance Abuse During Pregnancy Essay

Substance Abuse During Pregnancy Essay

EPSLO 4: Incorporate nursing’s professional core values, standards of practice, guidelines, commitment to excellence, and lifelong learning as a basis for professional nursing practice.

In your Journal summarize personal and professional achievements and accomplishments that you have completed throughout the baccalaureate nursing program at EC that refer to EPSLO 4: Incorporate nursing’s professional core values, standards of practice, guidelines, commitment to excellence, and lifelong learning as a basis for professional nursing practice. Substance Abuse During Pregnancy Essay

Attach a minimum of at least two examples of your work that supports EPSLO 4 noted above. Save your Journal entry as your Self-Appraisal for each module in your word document. The professor will request that you submit your journal entries for informal feedback at the end of each module. A Title page of this assignment with a summary of accomplishments (no more than 2 pages in length) is required with attached files as supportive evidence for each EPSLO. A minimum of one or two examples is required to support each EPSLO. Substance Abuse During Pregnancy Essay

Substance abuse is a mental illness that refers to the unsafe or misuse use of psychoactive substances, including alcohol and illicit drugs (World Health Organization [WHO], 2018). Psychoactive substance use can lead to dependence syndrome. Dependence syndrome includes behavioural, cognitive, and physiological sensations that develop following frequent use. Such syndromes include the urge to consume, difficulties with regulating substance use, continual use despite consequences, increased tolerance, and states of withdrawal (WHO, 2018). Furthermore, substance abuse during pregnancy is more prevailing than conceptualized, with up to 25% of child bearing women using illicit drugs. Substance abuse is significantly more common among women of reproductive ages than women in other populations. That being said, the average pregnant woman will take approximately four to five drugs during the duration of their pregnancy whereas 82% of those women take prescribed substances and 65% use nonprescription substances, including illicit drugs and alcohol (Wilson & Thorp, 2018). This paper will discuss substance abuse in pregnancy in relation to perinatal nursing. The incidence, physiology, morbidity and mortality with respect to the effects on the newborn and plan for labour and delivery, emotion and psychological support, discharge and follow up plans, in addition to nursing interventions, roles, and special considerations will be discussed. Substance Abuse During Pregnancy Essay

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Maternal substance abuse has reached levels of critical concern in North America over the past years. Wendell (2013), depicted that women currently represent 30% of the user population, with a majority of child bearing aged women. Substance abuse among the pregnant population varies significantly and is reflective of social status and income, race, age, cultural beliefs and norms, education and methods of screening for substance abuse (Cook et al., 2017). In addition, multiple risk factors for substance abuse include previous addictions, history of psychotic illness, history of physical or sexual abuse and environmental pressures (Wendell, 2013). According to Wendell (2013), the 2010 National Survey of Drug Use and Health reported an increase in the use of illicit drugs and alcohol among pregnant women. Trends suggest that tobacco, followed by alcohol, cannabis, cocaine, are by far the most commonly abused by this population (Cook et al., 2017). In Canada, new mothers reported that during their pregnancy 10.5% smoked cigarettes, 10.5% drank alcohol, and 1% used street drugs. However, one year later, the Perinatal Health Report revealed data depicting an overall increase in alcohol consumption and signifiant increases in smoking and drug use (Cook et al., 2017). These not so shocking trends are consistent with those observed in the United States, North America, and worldwide (Cook et al., 2017). Substance Abuse During Pregnancy Essay


Alcohol and illicit drugs have a significant impact on the human body. A significant number of health concerns arise from substance abuse. Liver problems as a result of alcohol consumption, respiratory impairment and lung cancers related to smoking, HIV/AIDS and hepatitis from injecting drugs, are a few examples supporting the impact that such substances have on the body (Center for Substance Abuse Treatment [CSAT], 2009). According to CSAT (2009), women who partake in substance abuse may have physiological problems related to gynecology. Impairments may be seen in women’s menstrual cycles, with cramping and changes with the duration and volume of menstruation. On the other hand, women who use illicit drugs can experience amenorrhea, misleading them regarding the signs of pregnancy or withdrawal (CSAT, 2009). Women’s substance use also poses risks to the unborn fetus, although the total damage that substance abuse has on a fetus is not fully studied and known. Fetal brain development is the most studied and the greatest life-threatening effect of substance abuse during pregnancy (Wang, 2014). A constant misuse of alcohol and illicit drugs during the first half of the pregnancy is likely to harm the wiring and connections of the brain which allows for the optimal brain development, maturity, and ability to learn (Wang, 2014).  Substance Abuse During Pregnancy Essay

Morbidity and Mortality: The Effects on newborn & plan of care for Labour and delivery

Substance abuse, both drugs and alcohol, during pregnancy is associated with mother and fetus mortality and morbidity. There is a strong correlation between substance use and a high-risk pregnancy and delivery. Substances such as opioids, smoking, and alcohol have proven increased risks of preterm labour, early onset delivery, poor or lack of fetal growth and development, and stillbirths (Whiteman et al., 2014). Increased hospital stays postpartum, exceeding five days, is common for mothers of substance abuse. In addition, during their extended stay, mothers of substance abuse are more likely to experience the complications, as significant as death (Whiteman et al., 2014). Substance Abuse During Pregnancy Essay

Maternal complications vary from one mother of substance abuse to another. Some complications may include respiratory, cardiovascular, neurological, psychoses, human immunodeficiency virus and/or metabolic. Bacterial infections, hypertension, seizures, vitamin deficiencies and malnutrition are the most common complications from the list above (Wilson & Thorp, 2008).

Obstetric and fetal complications include placenta previa, abruption of the placentae, and even rupture of membranes (Wilson & Thorp, 2008). In other cases, poor growth of the fetus may occur due to the lack of maternal nutrition adequate oxygen supply. Most mothers dealing with substance abuse often deliver prematurely and pose long term developmental effects on the baby (Wilson & Thorp, 2008).

Effects of substance abuse on the fetus and baby depend on the substance being smoked, snorted, inhaled, injected, swallowed or absorbed through the mucus membrane (Thorpe, 2008). Substances include congenital abnormalities, neonatal medical complication, and neurobehavioral alterations. Wilson and Thorp (2008), suggests that specific neonatal medical complications include sudden infant death syndrome (SIDS), neonatal abstinence syndrome (NAS), and respiratory distress syndrome. Substance Abuse During Pregnancy Essay

The plan for labour and delivery includes a comprehensive approach that is inclusive of communication, education, compassion, respect, and holism free of judgement. It is imperative that a full support of staff, resources, and tools are present during all phases of labour to support mother, baby, and the family overcoming upcoming challenges and barriers leading to a healthy delivery, post-partum period, and discharge (Whiteman et al., 2014).

Emotional and Psychological Support

They most vital component to caring for a mother with substance abuse is directing treatment and control during prenatal, intrapartum, and postpartum periods towards counselling. Counselling is to be provided by those who have acquired extensive learning and training in the treatment of substance misuse and abuse in addition to pregnancy and determinants of health (Brady, McCauley, & Back, 2015). Counsellors and substance abuse treatment programs use a variety of techniques and modifications that include motivational interviewing, identification of triggers, stress reduction, medication, cognitive behavioural therapy, positive reinforcement of abstinence and contingency management of support groups (Gopman, 2014). Furthermore, Gopman (2014) articulates the importance of alternative therapies such as massage, acupuncture, yoga, which were studied and found to be effective in grounding and stabilizing the mind. Women who are child bearing and suffer from substance abuse are encouraged to develop and participate in social networks that are separate and beyond their bad acquaintances with respect to drug use, thus redirecting them from the pressures that come with their personal relationships (Cook et al., 2017).  Substance Abuse During Pregnancy Essay

Discharge and follow up plan

There are many considerations and learning topics that need to be identified prior to a discharge after birth. Significantly, there are a far greater number of considerations that need to be identified and discussed for a woman who is dealing with the issue of substance abuse. Pain management, preventing relapse, breast feeding guidance, newborn development and assessment as well as transition to primary care are specific areas of discharge and follow up planning that need to be addressed (Gopman, 2014). Substance Abuse During Pregnancy Essay

Pain Management Postpartum

Both vaginal and caesarian births are accompanied by significant pain and discomfort postpartum. Keeping the history of a substance abuser in mind, pain medications are to be selected and used with severe caution. Non-Steroidal Anti-inflammatory Drugs, such as acetaminophen, is the most commonly prescribed medication in effort to relieve pain related to vaginal births (Gopman, 2014). Opioids may be the drug of choice when a significant increase in pain is felt in association with caesarian deliveries. Patients with a tolerance for opioids may have more difficulty controlling pain. It is suggested to allow for a higher or more frequent dosing of an opioid early on post-op, however quickly decreasing the need for opioid use to prevent relapse (Gopman, 2014). A discussion is critical to allow for the appropriate medications to be prescribed and so patient can understand the expectations and use of the prescription upon discharge. A follow up shortly after discharge is crucial to observe and track pain management related to drug use (Gopman, 2014). Substance Abuse During Pregnancy Essay

Preventing Relapse

After a delivery of a baby, substance abuse mothers may quickly have the urge to use. These mothers have a high risk for relapse as there is no longer a concern that exposure to drugs and alcohol will impact maternal and fetus health (Gopman, 2014). This population also has significant relapse rate due to the increased amounts of stress derived from postpartum depression, lack of sleep, hormone imbalances, and demands of parenting (Gopman, 2014). For the substance abuse mothers, close follow ups and early postpartum visits are crucial in preventing chances of relapse. Substance Abuse During Pregnancy Essay

Breast Feeding Support

Breast feeding is a topic that raises many concerns and questions for the lay postpartum women. However, educating to a substance abuse mother is critical for the wellbeing of both mother and newborn (Gopman, 2014). Methadone and buprenorphine are acceptable forms of synthetic analgesic drugs that enable substance abuse mothers to breastfeed while controlling their addiction. It is proven that the amount of drug used is unlikely to negatively effect the baby and just as unlikely to prevent or treat neonatal abstinence syndrome (NAS). Breastfeeding and skin to skin contact may in fact diminish some symptoms of NAS (Gopman, 2014). Breastfeeding may also be a motivating for mothers, thus keeping clean of substance abuse (Demirci, Bogen, &Klionskyb, 2015). Patients in this predicament need education regarding opioid replacement and health conditions such as Hepatitis C that may influence a women’s decision/ability to breastfeed safely. Some users also need to be made aware of how to properly feed their newborn prior to discharge if abstinence is not of interest, thus breastfeeding is unsafe (Demirci, Bogen, &Klionskyb, 2015). Substance Abuse During Pregnancy Essay

Newborn Development and Guidance

Recovery from substance abuse requires additional support to assure stability, health, and safety for both mother and newborn. Environmental resources that include parental and newborn care, substance abuse treatment, child development support that facilitate ongoing participation and trust are crucial in making sure that mother and baby are progressing and developing as they should be. Parenting classes and support groups provide opportunities for families to share knowledge and experiences with this matter (House, Coker, & Stowe, 2016).

Transition to Primary Care

Access to primary care services out of hospital is of utmost importance for women with substance abuse to attain. Encouraging women to seek visits with a current provider or a non-obstetric provider is an important message after delivery or potential loss of fetus (Gopman, 2014). The goal of this is to facilitate a smooth transition of care where the mother and fetus can have trust, respect, and compassion facilitated in an environment that can provide ongoing health care to a developing fetus and recovering or addicted mother. Substance Abuse During Pregnancy Essay

Nursing interventions and roles and Special Considerations

Nursing has an imperative role in the prevention, treatment, and interventions for those who are dealing with substance use in pregnancy. As per Stone (2015), early recognition, intervention, and screening are the most effective tools and strategies that help an individual recognize the issue of substance abuse before the misuse of substances progresses.

Nurses have the role and duty to provide non-judgmental, compassionate, and ethical care that is client centered and holistic. In fact, pregnant women with substance abuse disorders often fear stigmatization, shame, and judgement, therefore decline prenatal and postnatal care (McKeever, Spaeth-Brayton, & Sheerin, 2015). Identifying pregnant women with substance abuse is an ongoing challenge for nurses as well as other members of the interdisciplinary team, as these women have distinct care and treatment needs (Stone, 2015). An important topic that needs to be addressed for nurses and health care members caring for women’s who display these issues is recognizing the need for multidisciplinary management to promote and ensure positive maternal and fetal health outcomes as well as compliance with substance abuse treatment (McKeever et al., 2015). Nurses must advocate for the education and resources that this population requires, so that they can become active partners in their care (McKeever et al., 2015). It is reported that pregnant women dealing with substance abuse were seeking nurses who showed the ability to listen, hear, and respond to their concerns, while keeping them safe and build a trusting relationship (Stone, 2015). It is vital that nurses initiate and influence patients to partake in education and support services regarding the latest on perinatal addiction and pregnancy. Therefore, special considerations like those listed above are required by nurses and interdisciplinary team members in order to provide safe, ethical and compassionate care from prenatal to postnatal for this population (McKeever et al., 2015).  Substance Abuse During Pregnancy Essay


In conclusion, it is evident that substance abuse in pregnancy is significant issue in North America today. To understand substance abuse in pregnancy, the incidence, physiology, morbidity and mortality with respect to the effects on the newborn, plan for labour and delivery, psychological support, discharge, nursing interventions, roles, and considerations are components that need to be understood. After a comprehensive review of scholarly literature, it is clear that further education, support groups, screening, and public health access and supports need to be introduced. Such interventions will greater enhance the provision and care for addicted women and women trending towards addiction during pregnancy. Due to the fact that substance abuse is a global issue, municipal, provincial and national leaders must work together to provide supports and resources to mothers who abuse substances prior to conception or during their pregnancy. They are both crucial and essential in helping control, support, and reduce the number of pregnant women with substance abuse issues. All in all, it is imperative that perinatal nurses fulfill their duty to provide treatment by initiating early recognition, screening, and treatment programs for such individuals. It is the goal of nurses and multidisciplinary teams to put a stop to the increasing trend of this epidemic. Substance Abuse During Pregnancy Essay

Substance abuse during pregnancy can have a negative force on the health and wellness of not only the fetus, but that of the mother. The harmful effects of medications, alcohol and illegal drugs on an unborn child can be devastating and can have significant consequences to its use. Sometimes the effects can be faced and treated, and other times the outcome is a lifelong challenge. During the prenatal period, it is important that new mothers are informed of the different types of abuse, how they may affect the fetus, and the adverse conditions their child may be faced with before and after birth.

Most women are unaware of the risks associated with taking prescription medications while pregnant. Usually the fear…show more content…
Vitamin E has been linked to cardiovascular disease. Common use of Tylenol or aspirin for headaches or pain is also forbidden. Aspirin is linked to Reye’s syndrome affecting the fetus’ brain and liver. Tylenol is a powerful toxin that can cause liver damage and be fatal to the fetus. It is imperative that no matter what medications a mother may be taking, once the pregnancy is confirmed, it is crucial to discontinue use, and speak with a family physician regarding continued use or not. Once a mother is pregnant, everything she eats and drinks is a form of nourishment to the fetus and is ingested through the placenta directly to the baby. It is extremely important to determine whether or not any medications are safe or may cause complications with the fetus and delivery. Substance Abuse During Pregnancy Essay

Warnings and dangers of alcohol abuse have been recognized since biblical times. “Behold, thou shalt conceive and bear a son: and now drink no wine or strong drinks” (Holy Bible, Judges 13:7, 1970, p.261). There was even mention from Aristotle who noted “that foolish, drunken and harebrained women most often bring forth children like unto themselves, morose and languid.” (Buxton, 2004, p.42).

The time that the fetus is in the womb is one of the most crucial times in development. It is during this time that the fetus is easily susceptible to catching anything that the mother consumes or is exposed to. One of the many foreign bodies that can not only effect, but harm the fetus are known as teratogens. Teratogens are defined as environmental agents that can cause deviations from normal development and can be attributed to causing abnormalities or even death of the fetus during the developmental process. These teratogens affect the child’s health and the way they later learn and are mainly found in prescription drugs, illicit drugs, alcohol, caffeine, tobacco and also from viruses that the mother suffers from. During pregnancy, mothers are sometimes not aware or well informed enough to know that what they are consuming is having such serious effects on their baby, because teratogens can leave some of the most serious birth defects. Substance Abuse During Pregnancy Essay

Alcohol is one of the worst teratogens and can lead to the most defects because it is so widely consumed. More people are likely to drink an alcoholic drink rather than take harmful drugs, because alcohol is more widely ingested. Mothers are often unaware that frequently drinking these beverages can have long term effects on their child. It depends on what period of their pregnancy and how much is consumed that the severity of the defects is determined. Depending on how much the mother consumes defects can range from mental retardation to deficits in leaning abilities. According to a study conducted by Susan Maier, “When the children were studied at age 7.5, maternal binge drinking in the month prior to pregnancy recognition was the best predictor of neurobehavioral deficits in attention, memory, and cognitive processing as well as inflexibility in problem-solving”(Mailer). In most cases, the mothers who were unaware of their pregnancy and consumed alcohol later claimed that their children suffered from disabilities such as learning problems, being below average academically, and as well as being hyperactive and impulsive. These children have been noted by teachers to be slower learners and expressed behaviors that were incompatibly with learning at the average rate. These children that suffered from the mother drinking alcohol while pregnant are also described as restless, easily distracted and had a lacking in persistence. Later in the study that Maier conducted, “the children were studied again at age 11, children of binge-drinking mothers were still classified as having problems with distractibility, restlessness, and lack of persistence” (Maier). In more severe cases where the mother was an excessive drinker or a binge drinker, the effects on her baby were more severe. In some cases, there were occurrences of mental retardation, growth deficiencies, and morphogenesis. Among one of the more serious diseases is known as fetal alcohol syndrome. The signs of fetal alcohol syndrome are lower IQ, a higher prenatal mortality, and lower birth weight. Substance Abuse During Pregnancy Essay

Even though there are any ways alcohol can be harmful to the fetus, there are also many ways to prevent alcohol-related defects in the child. Prevention is quite easy when the mother is well educated and is fully aware of the risks. Ruth Little stated that public awareness of the different risks alcohol have on the fetus is clearly needed. She mentions three ways that can heighten the public’s awareness. Little says, “presentations in the media, by distribution of written and auto-visual materials, and by personal contact” (Little) are very affective in the public’s eye. There are many services to help woman become aware of alcohol hazards. These services include alcohol counseling, pregnancy and health programs and special crisis lines. All of these services help women gain a better understanding and give them a better grasp on the severity of alcohol consumption. If woman do not consider services like the ones mentioned above, they will not gain a better understanding of alcohol-related defects, and will have a higher risk of giving birth to a child who has severe mental problems. Substance Abuse During Pregnancy Essay

Teratogens, such as drugs are just as harmful as alcohol. Different drugs have different effects on the mothers and the fetuses as well. Teratogens can vary from drugs to alcohol. Any foreign body that enters the mother that is not beneficial or healthy to the fetus is categorized as a teratogen. With teratogens, there are six basic principles that apply to these specific agents. Some of these principles involve the organism’s susceptibility to the teratogens during development, the effects on specific organs, the severity of the effects due to the mother’s physiological state and general abnormal development. Some of the more harsh teratogens that affect the fetus in more extreme ways are illicit drugs such as cocaine, heroin, and even Thalidomide.

A major drug that is used and abused is cocaine. Most children born with cocaine addicted mothers are born addicted themselves. These babies are born with a variety of different problems. These problems include premature birth, stillborn babies, being low in weight, and can suffer from other defects as well. “Babies born to cocaine-addicted mothers are described as being irritable, liable to react excessively to stimulation, uncoordinated, and slow learners”(Bendersky & Lewis, 1998; Schuetze, Eiden & Coles, 2007). Most of the effects from cocaine show up later on in life for the child. These effects may also last for a long period of time. At around the time cocaine-born child is in preschool, that child will exhibit learning disabilities like delayed language, and will have trouble regulating themselves when given a simple novel task. Prenatal cocaine exposure can have serious effects on the child neurologically, causing these learning defects. Along with the learning defects, it can cause hemorrhagic brain damage, placental abruption, uterine rupture and even a malformation in head circumference development. Neurotoxic substances like cocaine will cause disturbances during the fetal period, leaving the child with incurable defects. Substance Abuse During Pregnancy Essay

Another serious drug that is unfortunately widely taken is heroin. Mothers that are addicted to heroin and other opiate based drugs pass down that addiction to their child during pregnancy. The children born to these mothers must be given substances like methadone post-birth, to prevent sever withdraw. These methadone treatments combined with natal care can be effective in the development of the child post-pregnancy. These babies suffer from extreme pre-mature birth and low birth weight. This is known as neonatal withdraw syndrome. Later learning disabilities can be somewhat prevented by the sporadical use of methadone. Heroin itself does not cause any major malformations. It also can cause slow fetal growth with could disrupt pregnancy by the mother giving birth to the baby but the baby being extremely underweight and under developed. “Heroin and other opiates are not associated with physical abnormalities in babies, however ongoing heroin use may result in your baby being born smaller than expected, earlier than expected and he/she may have other health problems”( Substance Abuse During Pregnancy Essay

An old used teratogen is a prescription drug called Thalidomide. This drug was given to woman between the 1950s to the early 1960s. It was given to woman to control nausea in the early stages of nausea. At first, when woman would take this they would give birth to children who has no signs of defects. But after a while, children were harmed by this drug. “Children were born, however, were born without arms and legs; their hands and feet were attached directly to their torsos like flippers. Some had defects of sight and hearing as well” (Lightfoot, Cynthia. Cole, Michael. Cole, Sheila R.). Just about eight thousand children were born with these types of deformities. Some more results from taking this drug are abducens paralysis, facial paralysis, renal malformations and congenital heart disease. It was because of the drug Thalidomide and its severe side effects that other drugs were tested and noting for having similar causes to abnormalities. For example, they tested antibiotics like streptomycin and tetracycline. Substance Abuse During Pregnancy Essay

Unfortunately, teratogens and other harmful substances that the mother consumes not only effect the baby, but also her. These substances were consumed due to a prolonged addiction brought on by psychological or emotional distresses. Most mothers are unaware by the harm they are causing to their baby, so they take and consume these substances in order to mend the emotional stresses they have in their life. Because their babies are born with such serious defects and abnormalities, the mothers are strained to provide intensive care and treatments for their child. Such treatments and care can be financially exhausting and time consuming for mothers that trying to balance a life between having a career and taking care of their baby or child. Taking a severely deformed or incapable child to these types of treatments can be emotionally draining for a mother or parent. Seeing the child suffer due to mistakes done by the mother, who is meant to be the prime caregiver, can be stressful and sickening to that mother. Aside from the care needed for the child, the harmful substances that the mother ingests can also leave her with serious health issues. All in all, mothers consuming alcohol, drugs, etc. are prone to being at risk physically and emotionally by the hazardous behavior they took part of during their pregnancy. Substance Abuse During Pregnancy Essay

In conclusion, there are various types of teratogens that can be severely harmful to a fetus. Alcohol, Cocaine, Heroin and Thalidomide are only four of numerous teratogens that will cause serious defects in a child. During pregnancy, mothers are sometimes not aware or well informed enough to know that what they are consuming is having such serious effects on their baby, because teratogens can leave some of the most serious birth defects. It is very important for a mother to understand completely what drugs can do to their babies. There are many facilities that woman can go to in order to receive more information about drugs and alcohol and the wide-ranging effects it has on their babies. There are also many facilities that will treat addicted mothers as well. If woman are informed about the defects in children that is caused by alcohol and other drugs then there will be less abnormalities in infants. The abnormalities and defects mentioned above can be easily prevented if mothers take the proper measures to become informed and are careful about what they ingest. What the mother consumes, the baby consumes as well. Substance Abuse During Pregnancy Essay