ABSTRACT
Drug use occurs throughout the social spectrum but is not a uniform phenomenon. Problem drug use, especially injecting drug use, that involves significant addiction and that causes major medical and social problems is closely associated with socio-economic deprivation (British Medical Association, 1997) which itself causes significant medical and social problems. As a result, the drug use that concerns obstetric services should be recognised as being one of a range of problems associated with deprivation that consequently cannot be managed effectively in isolation. Drug use can adversely affect pregnancy outcome (Chasnoff, 1991; Finnegan, 1982) either directly or as a consequence of its medical complications. Pregnant drug-using women should therefore be recognised as having potentially high-risk pregnancies, and, while much of their maternity care can be delivered by midwives, their management should be obstetrically led. Moreover since both the health and social problems associated with deprivation and with drug use can adversely affect pregnancy outcome, joint health and social management is essential. While deprivation and problem drug use are both associated with poorer health, including poorer pregnancy outcomes, they are also associated with ineffective service use, with pregnant drug-using women tending to attend late and irregularly for antenatal care. The challenge for service providers therefore is to provide maternity care which is appropriate to the women’s needs and which the women will want to use.
