Substance abuse among pregnant women and women in general

Women Drugs

Drug Use in Women Generally and During and Immediately Following Pregnancy: Implications for Nursing Practice

Substance abuse remains a highly controversial and socially prevalent issue that demands -- and has received -- attention form the medical and nursing community, with complicating factors that demand specialized care when dealing with substance abuse in pregnant women. Identified implications on nursing practice include screening practices, care provision during pregnancy, and long-term post-natal care for both infant and mother when a history of substance abuse exists. Direct changes to the provision of care are also suggested by the current literature. This paper examines the literature in order to provide a brief yet comprehensive and effective overview of substance abuse in pregnant women and its implications for nursing practice.

Introduction

Despite increased attention from the psychological and medical communities and a deeper understanding of the attendant and underlying issues, drug use and abuse remains a major problem in some populations. One specific population that has received a fair amount of attention in terms of substance abuse from scholarly sources and in social programs are pregnant women, as drug use during pregnancy can lead to many personal and social problems in addition to the medical problems directly associated with the drug use. This paper examines the findings of the effects, causes, and preventative measures that can be applied to substance abuse issues in pregnant women and women generally from a nursing perspective.

Findings and Discussion: Nursing Implications

Drug use among pregnant women and women of child bearing age has many implications for the practice of nursing, and these implications are not limited to the direct medical needs of substance abusers once they are identified. The actual identification of substance abusers can be very difficult, and has been the source of much scholarship and increased education efforts in many institutions and nursing bodies (Neushotz & Fitzpatrick 2008; Cox et al. 2007). Education on effective practices and policies for the identification of substance abusers has been incorporated into many nursing education curricula and placed into practice at many institutions, and this has led to an increased awareness of the substance abuse problem in general and as it affects pregnant women -- and women who might be become pregnant -- especially (Neushotz & Fitzpatrick 2008).

The direct medical implications of substance abuse among women in general and pregnant women in particular is also, of course, a major issue in nursing. The rates of many pregnancy complications, stillbirths, and birth defects and other ongoing medical problems for children are all increased dramatically by substance abuse during pregnancy (Watson-Moss et al. 2009). Early screening and detection of substance abuse problems in pregnant women can be highly effective, but such programs are not as widespread as they could be and thus do not reach the full number of women that could benefit medically and socially from such programs (Goler at al 2008). This leads to other more persistent issues.

Substance abuse by women often stops dramatically during a pregnancy, and studies have shown that the cessation of substance abuse and drug use usually persists into the first few months of pregnancy for the vast majority of women, even those with a long-standing history of substance abuse (Dowdell 2008). At the same time, socioeconomic factors and familial support have been identified as contributing to substance abuse problems -- and their cessation -- during later periods following pregnancy (Dowdell 2009). Though successful treatment programs do exist, without the proper and adequate personal support systems for the individual women with substance abuse histories relapse is highly indicated (Goler et al. 2008; Dowdell et al. 2009). Nursing practice must take this factor into account when prescribing and providing care and seeking out methods for the long-term health and wellness of pregnant and post-pregnant patients.

Changes to Nursing Practice

Current research suggests that the most effective manner in which nursing practice can be altered to combat and/or mitigate the effects of substance abuse during pregnancy is through early detection of abuse through effective screening processes (Neushotz & Fitzpatrick 2008; Cox et al. 2007; Goler et al. 2008). Substance abuse screening is an obvious first step in the treatment of substance abuse issues, and often the identification and acknowledgement with the patient of the substance abuse problem presents a major step forward in the patient's own acknowledgement of the issue and practice of self-care (Cox et al. 2007).