Protocols for drug use in pregnancy.

[crysobrn]

We seem to have more and more women coming in to deliver that are abusing various substances. We are a smaller facility and do not have a nicu. I'm curious what if any protocol you have for drug dependant mothers and then babies that deliver.

The other night we had a patient that was not supposed to deliver at our hospital. She drove almost an hour out of her way to come to us... Then after HOURS of complaining of vague complaints finally fessed up that she was dependent on adderall and had been taking 100+mg every day for the entire pregnancy. She was pleading for "help" stating that she just wanted to get off it before her baby was born. She was only 34 weeks and then starts contracting etc... She ended up being transferred to another facility for the possible need for a nicu. Just curious what your facility does for moms like this and nursery protocols too if you know those.

[crissrn27, RN]

The first thing in any protocol needs to be a culture of non-judgment for every mother. It took alot of courage and fear for her to come to you guys for help and calling it "help" shows the judgmental attitude that most women in this situation face. If they don't feel safe they will not tell of their addition and put their babies and themselves at risk.

As far as adderall goes, the major risk are premature birth and low birth weight. At 100mg/day I wouldn't be too concerned, as I have had women on a therapeutic dose of 60mg/day, so it could be much worse.

[crysobrn]

I actually felt very bad for this girl because she seemed to be having some major symptoms of withdrawl already. She was very believable once she trusted us enough to tell us what was going on. I just hope she can truely get help.

After doing some googling. I see that adderall seems to be pretty seriously addicting. And from what she was saying she needed a bigger and bigger dose just to function.

[crissrn27, RN]

It is very addicting and that doesn't magically change b/c someone is pregnant. You guys must have done something right for her to finally fess up. I'm glad she did, at least you know and can take the right steps during labor and delivery, and hopefully she will have time to come off the adderall before the baby is delivered.

[Elvish, BSN, DNP, RN, NP]

In addition to a UDS on mom and baby, we do abstinence scores with feeds on the baby to assess his level of withdrawal. If the scores get too bad (8 or higher for 3 consecutive scores) we start them on morphine 0.05mg/kg q4hr. If the scores are still high after a several days of morphine or if they are excessively jittery but not seizing, we start phenobarb too. We watch them for 5-7 days, as some kiddos won't get symptomatic til day 5 or so. (Keep in mind we are a big facility that takes care of these kiddos on a regular basis.) The kiddos stay with us in the nursery after mom is d/ced but can visit whenever they like.

Agree with the above poster who said that not judging mom will go a LONG way. Once she feels like she's not being judged lots of doors get opened and we are usually able to take better care of the baby as well.