With the majority of female inmates of childbearing age, drug and alcohol withdrawal during pregnancy is a fact of life in most jails and prisons. This is definitely a risky business as many substances affect fetal growth and development. Therefore, correctional nurses need to know the pregnancy status of female inmate starting at booking and have a clear understanding of the potential for drug or alcohol withdrawal while in custody.
Finding the Baby
Pregnancy evaluation at intake is recommended by the American College of Obstetricians and Gynecologists (ACOG) as well as the National Commission on Correctional Health Care (NCCHC E-02, G-09). Pregnancy risk can be assessed through screening questions about:
- Menstrual history
- Sexual activity
- Contraceptive Use
Urine pregnancy testing is inexpensive and some settings opt to perform pregnancy testing on all females of childbearing age. Once identified, pregnancy should initiate various activities such as evaluation of gestational age and enrollment in an obstetric program.
Finding the Substance
Many pregnancies in this patient population are high risk due poor lifestyle habits of the mother and lack of medical services. Female inmates have higher rates of smoking, alcohol use, and illegal drug use than the general population. All of these substances have detrimental effects on an unborn child. Identifying substance use at booking will determine any special considerations and interventions for a pregnant patient.
If a female inmate is found to be pregnant or likely to be pregnant, special attention should be given to determining the level of drug or alcohol use. Several screening tools are advocated for this purpose such as AUDIT, CAGE-AD, or SSISA. The important point is to screen for substances so that proper withdrawal intervention can be initiated.
Planning for Two
Substance withdrawal for the pregnant inmate means thinking about both the mother and the child. In fact, some withdrawals, like opiates, are too risky for the unborn child. Here is a quick breakdown on what to do for key substance withdrawals. The recommendations below come from the Principles of Addiction Medicine, Chapter 81: Alcohol and Other Drug Use During Pregnancy unless otherwise indicated.
Alcohol: The Federal Bureau of Prisons recommends that alcohol withdrawal of pregnant women be managed in an inpatient setting. This may be the safest route to take but is not always possible. The NYS Office of Alcoholism and Substance Abuse Services recommends the use of a benzodiazepine taper and careful, frequent evaluation of withdrawal symptoms for pregnant alcohol-involved patients.
Benzodiazepines: Benzodiazepines and other sedatives/hypnotics can be withdrawn during pregnancy with careful management as abrupt withdrawal can lead to spontaneous abortion or premature labor. The second trimester is the optimum time for this withdrawal to reduce either of these outcomes.
Opiates: Opiate withdrawal has a high likelihood of miscarriage and premature labor. Therefore, pregnant opiate users (including those using methadone and buprenorphine) should be carefully managed by a specialist and may be maintained on the drug through pregnancy.
Stimulants: Stimulant use, such as cocaine and methamphetamine, during pregnancy can lead to preterm labor, placental abruption and intrauterine growth restriction. However, stimulant withdrawal does not cause significant physiologic consequence to the unborn and can be managed according to protocol with careful management.
In all cases, a pregnant substance-involved patient needs specialized obstetric medical care and close observation during the withdrawal period to have a healthy outcome.
How are you managing alcohol and drug withdrawal for your pregnant patients? Share your thoughts in the comments section of this post.
To read more about alcohol and drug withdrawal in the correctional setting see Chapter 5 in the Essentials of Correctional Nursing.
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