OBSTETRIC LIAISON IN DRUG DEPENDENCY

This study describes the first two years of an obstetric liaison servi ce between the Liverpool Drug Dependency Clinic and the two local mate rnity hospitals. The service comprised, medical officer, drug liaison midwife and a designated obstetrician at each of the hospitals. A tota l of 88 women were seen from whom there were 60 deliveries producing 6 1 babies. Only two women delivered without either service identifying their pregnancy. This compares to a previous estimated rate of 75% of drug users being undetected by the obstetric services. The amount of m ethadone a woman was taking did not predispose to any specific obstetr ic intervention. There was a higher rate of small for gestational age babies in this group but other factors may be more important than a mo thers drug use. Higher levels of maternal methadone did not reduce foe tal weight. There was a tendency to increase the risk of neonatal opia te withdrawal symptoms and premature labour with higher doses of metha done, although this requires further study. The multidisciplinary appr oach of the Liverpool Drug Dependency Clinic allowed in a majority of cases for assessments prior to delivery, so reducing the number of cri sis child protection conferencing after birth. The multidisciplinary t eam endeavoured to establish normalisation policies for other health c are workers who have contact with pregnant drug users on treatment, an d in so doing, encouraged a change in the general midwifery staffs att itudes, to be more positive and accepting rather than discriminatory. We suggest that prescribing methadone within a harm reduction philosop hy has produced acceptable outcomes for opiate dependent women and the ir babies.