Methadone Treatment For Pregnant Women: A Case Study

Methadone Treatment Benefits and Risks

Discuss about the Evaluative Case Study for Australian Health Department.

For more than a decade, methadone has been used for the treatment of the opiate-addicted individuals for separating them from their addiction to morphine, heroin and other opioids.Methane is a synthetic narcotic which interferes with the capability of the heroin to focus dopamine receptors inside the brain.The use of methadone helps in controlling the drug addicts from further harming themselves.The opioid use in the time of pregnancy has increased rapidly in the current years which in turn as risen the chances of the epidemic in the women of the general population. According to the report of Australian helath department conducted by the Australian Bureau of Statistics ,more than 41.6% of women in the current era are diagnosed with the addiction of drug and alcoholism during and before their pregnancy. not only women, specifically preganant women, but also infants and kids are affected due to such substance abuse through out the world and among different race and ethinicity. therefire, it is necessary to carry out screening It should be an essential part of the comprehensive obstetric care and it should be done in the first parental visit with the woman who is undergoing the pregnancy. Multidisciplinary follow-ups must include developmental, medical and social supports (The Royal College of Midwives, 2012). Neonatal abstinence syndrome. can alkso help to diagnose the use of opoids while pregnancy as the women who uses such service whie pregnancy develops the sympotoms of the syndrome. It has often been found that proper universal screening, brief intervention, and treatment referral for pregnant women with the use of opioid improve and develop outcomes regarding infants and maternal health. Besides the psychological benefits, the treatment related to methadone is one of the best methods for the treatment of opioid dependence due to its pharmacokinetic properties. Some of the other benefits of the treatment are that the methadone is generally active when they are taken orally, furthermore, it is associated with fewer and lower sedating and euphoric effects that antagonize that effects of other opioid medications. But too much use of the methadone drugs during pregnancy tends to cause preterm labor and the neonate with very low birth weight, it further tends to cause development delays among neonate.Too much use of drugs during pregnancy is harmful to the foetus.

The situation explains the case of Ms. Robertson who is a homeless person who currently seeks diagnosis and helo to the emergency of the Tweed Hospital being pregnant for 36 weeks.The hospital suspected SROM, signs of opioids withdrawals and Hepatitis C positive in Ms. Robertson.Furthermore, she was not treated with any antenatal care and was suspected intrauterine growth restriction.She was transferred to the daily assessment unit of the women’s care at the hospital for a proper assessment of pregnancy.

Screening Methods for Pregnant Women with Opioid Addiction

A midwife noticed that the foetus of Ms. Robertson was measuring around 32 weeks. Besides she came to know that Ms. Robertson has been using 100 mg illicit morphine on a daily basis and was smoking 10 cannabis cones daily in the past years. After successful consultation with the midwife, Robertson was sent for a growth scan USG for the effective access to the condition of the foetus. Furthermore, she was recommended to immediately contact the opioids treatment services for the replacement of the opioid therapy.

Ms. Robertson was raised and abandoned by her parents who had a history of problematic substance abuse.Her parents were alcohol users, opioid and chronic cannabis. According to reports, the patient started using cannabis at the age of 8 and morphine at the age of 16. Since then the use of these substances and other opiates has been a bigger issue that results in an increased tendency of criminal behaviorin her personality. further issues related to health like custodial sentences also increased. Furthermore she suffered from anxiety from 10 years and used alprazolam from a very young age.

In connection with the given case study, Ms. Robertson has an extensive history of the child abuse. According to the study, she has been the victim of sexual abuse by her father from the tender age of five at repetitive occasions. According to the reports and explanation by the World Health Organization, child abuse is defined as the forced involvement of a child in any sexual activity that she is unable to comprehend (World Health Organizaton, 2018). The abuse is evidenced generally among the child and an adult who is generally in the relationship of responsibility, power, and trust. It has been seen that children who are exposed to traumatic experiences often tends to encounter issues throughout their life from childhood through adolescence to their adulthood (Jonson-Reid, Kohl & Drake, 2012).

Ms. Robertson stated that she was not given any treatment or medicines when she was pregnant.She further stated her fear and anxiety over the safety from her ex-partner who had the history of domestic violence an drug abuse.

The assessment of antenatal psychology of pregnant women is one of the most important roles for the midwives. According to the National Perinatal Mental Health Action Plan by the Commonwealth Government, it is important to assess the mental, psychological and wellbeing of the many women undergoing the perinatal period(MCCAULEY et al., 2011).According to this plan, all women should be assessed in pregnancy and postnatally for ensuring that proper referral is made towards the mental health care professional. One of the proposed tools for the baseline assessment is the Edinburgh Postnatal Depression Scale (Shiu & Ensom, 2012). 

Case Study

After the birth of her baby, Ms Robertson was referred to the Safe Start programme as one of the essential parts of her treatment plan. The Safe Start programme focuses on helping the vulnerable or the risky families during the time of pregnancy.Furthermore, she expressed interest to join the Mums Using Methadone Services (MUMS) at the hospital.MUMS is generally the service targeting the pregnant women who are under the methadone treatments and have a history of drug and alcohol intakes.Ms. Robertson was suggested to join the program in the context of her treatment that aims to help her reduce the harm or the risk to her and her neonate.As the essential part of her treatment plan, Robertson was referred to a self-referral treatment plan that aims to improve her psychological characteristics and her nature of substance abuse by social constructivism and normalizing behaviors.Ms. Robertson was further prescribed to visit a methadone and opioids clinic to receive medication based therapies for abolishing the addiction of her towards the opioid-based drugs and alcohol. Treatments such as MUMS /DIPS Programme (ROSH ASSESSMENT) which prohibits the risks of the significant harm to the women bearing a child was suggested to Ms. Robertson as the plan for her diagnosis treatment.Lastly, Ms. Robertson was prescribed to intake Subutex pill for treating her addiction and dependence to the opioids.

One of the highest prevalent diseases among the women during their childbearing years is the psychiatric disorders. Among 80.46% of the women who had the history of drug addiction and alcohol dependence reported not to receive any care and treatment during her pregnancy. Furthermore, it has also been seen that these women often tend to have psychological issues of substance abuse and often the child protection services of the state separates and removes their children from them in the inspection of their vulnerable nature and drug addictions (Jonson-Reid, Kohl & Drake, 2012). It has often been seen that women with serious mental illness experiences lower rates of antenatal care since the fear of encountering stigma and the judgmental attitudes of the healthcare professionals are still prevalent in the society (RANZCOG College, 2016). This often results in the relapse of their mental illness together with difficulties in parenting and an increased risk of losing their children.

The concept of the opoid dependency is a much-recognized phenomenon in the current decade. Women have been subjected to this disorder for many ages. This disorders includes issues such as anxiety, post-traumatic stress disorders are higher in chances among the women in relation to childbirth (Child Welfare Information Gateway, 2013). The impacts of negative experiences in life on the psychological well-being of the women have the tendency to the higher risk of obstetric complications. Women experiencing mental illness generally tend to have the high risk of maternal self-harm, maternal harm towards baby and impaired relationships among mother and infant.

Antenatal Care and Psychiatric Disorders

It has been observed that due to opoid dependency, preganant women develop  psychiatric disorders that enhances the risk of self-har and increases suicidal tendency. Pregnancy and the postpartum are stages of increased sensitivity to psychiatric disorders which may confound treatment of substance abuse. It has been observed that more than 60% of women having opoid dependency suffer from co-morbid psychiatric disorder. women suffering from substance abuse are at increased risk of psychological distress compared to women that do not use such products as well as those women are found to have poorer mental outcomes. There are imperfect data on suggested treatments of psychiatric disorders in pregnant women with co-morbid opioid dependence. Though, it is recommend that synchronized management of psychiatric symptoms with treatment of the substance use disorder can help the women in such situation.

Another most significant issue related to the mental illness is the increased risk of obstetric complications. Some of the key and basic risk factors of obstetric are an unplanned pregnancy, hypertension related to pregnancy, cesarean issues and early discharge from healthcare institutes (NSW DEPARTMENT OF HEALTH, 2009). Some of the related complications include low birth weight, intrauterine growth retardation, and risks of preterm births. Researchers revealed the increased risk of complications during the pregnancy and the neonatal period. It has been noticed that women suffering from affective psychosis and schizophrenia have the tendency to the risk for complications related to obstetrics.

Conclusion

Midwives hold the power and the opportunity to generate a difference towards the outcomes for both the baby and the mother. This is because they are enabled and expert in providing continuous care during this vulnerable time of any women. They are generally considered with a positive regard by the health care profession which results in the formation of a deep bond with the women in care. Further education and training regarding the mental health and mental illness in thus necessary for the midwives. This is because they can assess the wellbeing of the women who are pregnant and have mental health issues. Drug addiction is a serious issue and dependence towards frequent alcohol intake and drug addiction has a serious impact on the health of the pregnant women and her neonate.Thus the use of methadone treatment should be properly used in case of pregnancy and the patients should be diagnosed with anti-drug addiction therapies and treatments.

References

Australian Bureau of Statistics. (2017, September). 3303.0 - Causes of Death, Australia, 2016. Retrieved from https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/3303.0~2016~Main%20Features~Drug%20Induced%20Deaths%20in%20Australia~6

Centre for Population Health. (2006, November). Opioid Treatment Program: Clinical Guidelines for methadone and buprenorphine treatment. Retrieved from https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2006_019.pdf

Child Welfare Information Gateway. (2013). Long-Term Consequences of Child Abuse and Neglect. Retrieved from https://www.childwelfare.gov/pubs/factsheets/long-term-consequences/

HOW TO WORK WITH SURVIVORS OF CHILDHOOD SEXUAL ABUSE (CSA). (2018).

Jonson-Reid, M., Kohl, P. L., & Drake, B. (2012). Child and adult outcomes of chronic child maltreatment. Pediatrics, 129(5), 839-845.

MCCAULEY, K., ELSOM, S., MUIR-COCHRANE, E., & LYNEHAM, J. (2011). Midwives and assessment of perinatal mental health. Journal Of Psychiatric And Mental Health Nursing, 18(9), 786-795. https://dx.doi.org/10.1111/j.1365-2850.2011.01727.x

NSW DEPARTMENT OF HEALTH. (2009, September). NSW Health Review of Substance Use in Pregnancy Services. Retrieved from https://www.health.nsw.gov.au/mentalhealth/programs/da/Documents/review-of-substance.pdf

Parolin, M., & Simonelli, A. (2016, August). Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004230/

RANZCOG College. (2016, July). Substance-use-in-pregnancy. Retrieved from https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Substance-use-in-pregnancy-(C-Obs-55)-Review-July-2016.pdf?ext=.pdf

Shiu, J. R., & Ensom, M. H. (2012, September). Dosing and Monitoring of Methadone in Pregnancy: Literature Review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477836/

The Royal College of Midwives. (2012, November). Maternal Emotional Wellbeing and Infant Development-A Good Practice Guide for Midwives. Retrieved from https://www.rcm.org.uk/sites/default/files/Emotional%20Wellbeing_Guide_WEB.pdf

World Health Organizaton. (2018). Child maltreatment-Violence and Injury Prevention. Retrieved from https://www.who.int/violence_injury_prevention/violence/child/en/