Improving the health and family potential for mothers with substance use problems


The use of drugs and excessive alcohol use during pregnancy results in increased health risks for both mother and baby. Of particular importance is the increased risk of pre-term delivery problems and neo-natal abstinence syndrome.

The 2004 UK Confidential Enquiry into Maternal Deaths Report, 'Why Mothers Die'1 found that substance misuse accounted for 8% of maternal deaths. This report identified a wide range of risk factors associated with substance misuse, including social disadvantage, unemployment, poverty, social exclusion, domestic violence, psychiatric illness, late booking and poor attendance for antenatal care. In particular the report highlighted that a common feature of many of the deaths was poor multi disciplinary and inter-agency working. The report stressed that pregnant women with problem substance use should not be managed in isolation. Policy and good practice publications recommend that the most effective way of delivering services to pregnant women with substance misuse problems is by integrated multi disciplinary team care which includes dedicated staff from maternity, neonatal, child health, substance misuse and social work services. While varying models of service delivery have been established in different areas, all have as their basis an effort to provide an integrated multi disciplinary approach to care.2,3,4


There has been growing recognition of the impact of parental drug misuse on infants, with an increasing rate of referrals between community care, children and families and substance misuse services within Edinburgh. This recognition has led to the development of a new integrated Pregnancy and Parenting Support Team within Edinburgh, which has been endorsed and supported financially by the Scottish Executive.

The development of this specialist team for substance misuse is focused on meeting the increased demand for care and to enhance the capacity and effectiveness of services and the interventions of professionals.

The work of this team focuses on two equally important aspects, namely the care of the newborn from a child protection perspective and the care of the pregnant woman/parents from a substance use perspective.

This focus on both the child and mother is achieved through the following principles of working:

PrePare TEAM

The PrePare Team comprises a multi disciplinary team of community midwife, psychiatric nurse, health visitor and nursery officers who together form a city-wide service. It focuses on pregnant women with substance misuse problems and infants considered 'high risk' because of injecting drug use, chaotic lifestyles, child protection issues. Based at Stenhouse Family Centre, the team provides:

Referrals to the team are accepted from GPs, community midwifery teams, health visiting teams, social work, drug & alcohol services, maternity (post natal/neonatal wards) and child health services. The team works collaboratively with NHS colleagues, social work teams (Children & Families, Community Care, Criminal Justice, Resource Teams, Home Care, etc), Education and Police. Funding has also been allocated within the NHS for the development of the proposed midwife and health visitor posts. Edinburgh Drug Action Team has committed resources for the recruitment of the community mental health nurse post while City of Edinburgh Council Children and Families Department are providing physical resources of a team base and other administrative and structural support.

The establishment of this new service can be seen to represent a genuine multi disciplinary approach across partner agencies and it will be evaluated rigorously to determine whether this model should be adopted more widely.

Child Protection

In last year's report we set out an approach to safeguarding children and families in difficult circumstances. The PrePare team is one of the ways in which we are developing services to meet the child protection needs of our local population.

In the last year we have also opened a specially designed unit for examining suspected victims of abuse. This provides examination facilities that are state of the art (with video colposcopy) but are not intimidating. Health, Social Services and Police staff work together in the Amethyst Unit to deliver integrated care for patients.

NHS Lothian provides a forensic service to victims and people in custody on behalf of Lothian & Borders Police. The service level agreement encourages the best practice and ensures that the service meets the required quality assurance and clinical governance standards.

To sustain improvement in child protection services we are one of the lead agencies involved in developing a managed clinical network for child protection for South East Scotland. Combined with extensive training for staff across agencies (6150 staff are now trained), the network will support further development of expertise and sharing of good practice.

Improving the care for the most vulnerable children signals our intention to increase the chances for health for all children, reducing the instances of harm to health and increasing their opportunity to grow up in a safer, healthier environment.


1. 'Why Mothers Die 2000-2002' CEMACH report 2004

2. 'Models of Care for the Treatment of Drug Misusers' National Treatment Agency for Substance Misuse, Department of Health 2002

3. 'Maternity Standard, National Service Framework for Children, Young People and Maternity Services' Department of Health 2004

4. 'Framework for Maternity Services' Scottish Executive 2001 p116-117