Introduction

Imagine asking yourself the question, “How would I describe a typical pregnant woman who uses drugs?” You might reply that she comes from a different social class, cannot think beyond the pregnancy, uses jargon, and doesn't listen or care about the welfare of the child. However, my experience when asking drugusing women what they thought about the typical obstetrician is that they say the doctor was from a different social class, could not think beyond the pregnancy, used jargon, and didn't listen or care about the welfare of the child.

There are many barriers to delivering effective care to women who misuse substances. Seeing the situation from their point of view is always a good start.

Substance Misuse: General

Lifestyle

Much of the harm caused by illicit substances is indirect, linked to the associated lifestyle needed to fund drug use and the inherent risks of administration. Many of the risks are greater for women than for men. Women are more likely to use prescribed psychoactive medication, have less capacity to metabolize the drug (such as alcohol), hide their use for fear of stigmatization, and hence increase their vulnerability to victimization. As many as two-thirds will have a concurrent mental health problem, and even if such problems do not currently exist their susceptibility to depression, suicidal ideation, and post-traumatic symptoms as a result of victimization is much greater.

Eventually the lifestyle revolves around the drugs, risk-taking increases, and there is self-neglect and social isolation. As tolerance of illicit drugs develops, the intravenous route becomes more attractive despite the risks of bloodborne viruses, abscess formation, septicemia, endocarditis, vascular insufficiency, deep venous thrombosis, and thromboembolism.

Identification of Substance Misuse

There is no shortcut nor any single stereotype to recognize. The only method that seems to be useful in most cases is to ask the woman, and to ask again later in the pregnancy. While some women may be offended at this line of questioning, if it is presented as routine it may be more acceptable. It is important not to be offended if it turns out the woman lies: it is understandable, for disclosure is a huge step and can take time.