Reducing risks during pregnancy

Working with parents to reduce risks for their baby

Babies are safer when their parents are getting antenatal care and treatment for their alcohol and other drugs use.

What can stop women from getting help?

There are many reasons why a woman who is pregnant and using alcohol and other drugs may be reluctant to get help. These include:

• shame and guilt
• fear of Child Safety involvement
• fear of having a child taken from their care
• feelings of depression and low self-esteem
• belief or hope that they can change without help
• unsupportive, controlling or violent partner
• not having enough information about available services
• difficulties getting into treatment due to limited places and high demand
• lack of services due to geographical location.

Best interventions for a woman who is pregnant

The best interventions for pregnant women are holistic and person-centred. These interventions look at the specific needs of each pregnant woman who uses alcohol or other drugs — both at a practical level such as safe housing and financial assistance to mental health care, and the right treatment for their problematic substance use. Holistic care should encompass a range of health and psychosocial domains and address any practical barriers to the woman getting treatment — such as transport, money, housing, violence.

Treatments can include withdrawal or medical treatments with specific drugs, as appropriate, psychosocial interventions and nutritional support.

After delivery, follow-up and coordination is particularly important, including ongoing alcohol and drug treatment, medical management, health and developmental assessment of the baby, parenting support, contraceptive advice, and referral for additional support services.

Antenatal planning with Queensland Health

Expectant parents need Queensland Health and Child Safety practitioners to work together. Pre-planning is an essential part of casework with expectant parents. Some of the things to explore with service providers and the parents prior to the baby’s birth include:

• minimising the shame and stigma parents may feel
• monitoring for neonatal abstinence syndrome
• engaging alcohol and other drugs professionals to support parents during the antenatal period—including getting involved in prenatal care and appointments
• current substance use and what this may mean for the birth, their behavioural and emotional presentation and any worries you have for their baby once born
• supports needed in hospital and once discharged
• where parents are up to in their readiness for change and how professionals can work together with them to motivate and sustain change
• breastfeeding (if this is what the woman wants) and how she might do this safely.

Involve clinical and other health professionals during the hospital planning meeting (via phone or in person) to ensure advice is shared.

Readiness for change

Consider how ready an expectant or new parent is to change the way they use substances.

Ask them:

• How do you feel about your alcohol and other drugs use now that you know you are going to be a parent?
• Do you want to change your substance use?
• Have you thought about changing the way you use alcohol and other drugs but not taken action yet?
• Is your alcohol or drug use something you feel does not need to change? Tell me more about that?

The kind of parent they want to be

Encourage parents to talk about their feelings, including their hopes and fears. Ask them:

• How do you feel about becoming a parent?
• What you are most excited about?
• What fears or worries do you have?
• What kind of mum or dad do you want to be?
• What about being a parent are you looking forward to?
• What will be challenging about being a parent?
• Sometimes becoming a parent can make people think about their own childhood. Can you relate to this? What was your childhood like?
• Now that you're about to be a parent, what do you think about your childhood?
• Did you grow up with alcohol or drugs around you? Tell me more about what it was like.
• Compared to your parents, what would you do the same or different for your child?
• Where does your alcohol and other drugs use fit in when you think about the kind of parent you want to be?

Listen out for her ability to make positive change

If alcohol and other drugs use was a worry that has previously contributed to a woman’s child being taken into care, ask her what has changed or is different now. Ask what she has done or tried to do since then. Talk about how you can work with her this time. If it is an option, let her know that parenting her unborn child is a possibility.

Listen for indications of change in your conversations, for example, statements such as ‘I want to stop’ or ‘I want to get help’. Ask her if she has tried to stop or take back her life from substance use in the past. Commend her for taking steps and ask her what happened and how it could be useful to her now.

Use an ecomap to talk about the family, friends and community that she is a part of. Use the Circles of Safety and Support Tool to explore who in her life knows nothing, something or everything about her substance use. Ask her about any cultural traditions, perceptions and values about parenting her baby.