The risk of a mother with hepatitis C infecting her baby during pregnancy or during the birth is approximately 6%, but ascertain- ing time of infection is difficult. It does not occur during concep- tion but is transmitted vertically (Ohto et al.1994).
Babies are sometimes found to have antibodies to the virus, but these usually disappear by the time the baby is 12 to 18 months old, demonstrating that antibodies are passed from mother to baby.
Diagnosis may not be possible until the baby is more than one year old, but there is a polymerase chain reaction (PCR) test that may detect the virus in the first few months.
Women who are hepatitis-positive require focused counselling and sensitive support to reduce the stress that may be experienced with concern for potential effects on the fetus. Media information campaigns are increasing understanding of hepatitis – this will increase public awareness and access to screening and testing.
Infected mothers are often concerned about passing the virus on to their other children, but the risk of transmission is low and parents can be reassured that kissing and cuddling a child is safe.
Pregnant women who use drugs and who have been involved in high-risk behaviours may present as HIV-positive. The risk is of vertical transmission of infection to the fetus, occurring at any time
Substance Misuse 131 of pregnancy but in particular at the time of delivery. All women should be given information to enable them to make an informed choice about testing, treatment and obstetric management.
Conclusion
The pregnant woman who uses drugs may present challenges and concerns for those providing care. Listening to the woman and her family is of paramount importance, throughout the whole childbirth continuum and beyond. Often, due to the nature of the women’s addiction, the environment in which they find them- selves leads to resistance, reluctance to seek support and fear of authority. Midwives and all healthcare workers who come into contact with women who misuse substances must consider each woman as an individual. Maternity services should promote a culture of non-judgmental care to all women, including those who misuse substances (Drummond and Fitzpatrick 2000).
For midwives, careful early assessment of women who misuse drugs, alcohol or substances provides an opportunity for referral to appropriate services. This may be facilitated by a nominated drug liaison midwife or any midwife in maternity services. Education plays a major role in the development of midwifery roles and the delivery of services. Joint training opportunities enable a common vision of maternity and drug treatment care for this client group.
The role of the midwife is central to the health and well-being of all pregnant women, especially those women who are vulnerable, as described in Chapter 1. The midwife is in a position to provide infor- mation on health issues, assessment, review, support and specific care during the pregnancy, birth and after delivery. Maternity ser- vices offer an opportunity to be involved in wider partnership work- ing and developing new roles through joint working and placements with a range of organisations that include community drug services.
Key implications for midwifery practice
•
Think about how you speak to and care for women who misuse substances, and remember their double vulnerability.•
How many pregnant women misuse substances in your area? How does this compare with the national average?•
Have the Models of Care recommendations been implemented?If not ask your local DAAT commissioner why?
•
Who leads on co-ordinating care for pregnant women in your area?132 Essential Midwifery Practice: Public Health
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