ABSTRACT
This chapter covers the key areas: identification of women with drug/alcohol dependency issues; problems of non-identification; screening for drug misuse; risks/complications of dependency relating to pregnancy; inter-agency working, confidentiality and child protection; antenatal care; labour and delivery care; and postnatal care for mother and baby and breastfeeding. Midwives are used to working with other healthcare providers when planning care for women with complex physical needs but may not feel quite so confident when working with non-health agencies, example, prison services, probation services or social services. Constipation is a cause for concern in opiate dependent women because the abdominal pain associated with it may lead the woman to believe she is miscarrying or in early labour. Opiate levels need to be maintained so that routine analgesia will work and the risk of an unnecessary caesarian section or foetal blood sampling is reduced. The effects of alcohol on the infant are not clear but women should restrict their intake whilst breastfeeding.
