Recovery Plus: Workplace wellbeing your library’s essential reference September 2016 45 About the author Valerie M Kading NP, MSN, DNP serves as the associate director of medical operations for Sierra Tucson rehab and was an adjunct professor at Grand Canyon University. Previously, Valerie practiced as a board certified psychiatric mental health nurse practitioner for 10 years, working with patients with various mood disorders and co-occurring substance abuse diagnoses. She specialises in working with perinatal women experiencing psychiatric illness. Valerie is flying to Recovery Plus in London in November – catch her there. Maternity issues at work are made even more complex when substance use is involved. Valerie Kading shares the statistics and briefs us on what to address and what is helpful. Katon, 2010; WHO, 2012b). A systematic review revealed that postpartum depression symptoms were present in 19.7% to 46% of postpartum women who abused substances and those with a history of substance use (Chapman & Wu, 2013). In a sample of 125 women, one-third of opiate-addicted mothers screened positive for major depression, and almost half experienced postpartum depression six weeks post-delivery (Hoolbrook & Kaltenbach, 2012). Perinatal women experiencing depression might be at a higher risk for substance use as a means to self-medicate. Addressing substance use and co-occurring mental health concerns is imperative for a positive outcome for the mother, unborn child and family. Substance use during pregnancy has been linked with negative outcomes, including increased morbidity and mortality for the woman and her child. Pregnant women abusing substances are less likely to obtain consistent obstetric care and have poor medical follow up. Obstetric complications associated with opiate dependence include miscarriage, preterm labour and postpartum haemorrhage. Adverse outcomes for the foetus include stillbirth, prematurity, intrauterine growth retardation and neonatal abstinence syndrome. In a sample of 247 subjects, cocaine and heroin use were both positively associated with IUGR, preterm delivery and low birth weight (Pinto et al, 2010). Healthcare providers are at an optimal position to screen for substance use among perinatal women, and employers to urge them to do so. Women with histories of psychiatric or substance use should raise concerns and trigger focused assessment on substance use. Screening for the use of substances should occur routinely in obstetric/gynaecology, primary care and psychiatric practices to immediately capture substance use among perinatal women and result in referral for treatment. Evidence-based substance use screening tools for perinatal women include Assist, Crafft, Substance Use Risk Profile-Pregnancy Scale, T-ACE, TICS and Tweak (Goodman & Wolff, 2013). These range in sensitivity from 50% to 91% and are validated for prenatal and pregnant women (Goodman & Wolff, 2013). ÂÂ For a full list of references, click here.
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