Early Assessment and Resource Provision for Pregnant Women With Substance Use Problems

Abstract

Substance use is an epidemic, with the most vulnerable victims being neonates who are born to women with substance use issues. Drug-exposed newborns require a greater level of care, which results in prolonged lengths of stay and increased costs. The stigma of substance use creates a barrier to quality care for the mother and her newborn. Providers lack an awareness of treatment protocols and resources for substance-using women within their community. Family development is delayed while safety concerns for the newborn are considered. The project setting was determined by the need for a diverse representation of the target population, including cultural and socioeconomic variables. Two separate departments—the hospital labor and delivery unit and the emergency department—as well as an outpatient obstetrics and gynecology physician’s office participated in the project. Nurses in each area were educated on the impact of substance use in pregnancy and administration of the 4P’s Plus validated screening tool. The screening was completed with pregnant women during their first prenatal visit in the provider’s office; in the hospital labor and delivery unit or emergency department, when presenting to the community hospital with limited or no prenatal care; or as part of the patient’s routine admission assessment. Women who screened positive were offered education on substance use in pregnancy and a resource brochure inclusive of support and treatment sources in the St. Louis metro area. Follow up was conducted either by telephone or in person with patients who screened positive and accepted resources 1 month after the initial screen. Fifty-six screenings were completed; 61% of women tested positive and 39% tested negative. Positive office screenings were 51% versus 86% in the hospital. Most positive screenings in the office were for cigarettes only, whereas hospital screenings were for polysubstance use with illicit drugs. None of the women in the office admitted to using illicit drugs. All of the women who screened positive accepted the education and resources. Data demonstrated the benefits of early screening and resource provision for substance users who were pregnant and less likely to get prenatal care. Nurses’ knowledge of caring for pregnant women who were substance users improved. Project results stimulated a greater awareness of the epidemic and highlighted the need for ongoing community support.