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New resources to support pregnant people who use substances

More resources are now available for expectant moms who use alcohol and other substances.

The B.C. Centre on Substance Use (BCCSU) has developed a new clinical guideline supplement to care for them.

The centre has also expanded the 24/7 Addiction Medicine Clinician Support Line for midwives in B.C.

The expansion of the support line was completed in partnership with the Midwives Association of British Columbia (MABC). 

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The province says midwives “play a unique role in establishing a trusting relationship with a patient that otherwise may have little to no contact with medical professionals.” 

“They also offer a critical opportunity to connect the patient with the health-care system and to offer evidence-based treatment and care for patients using substances,” the province added. “With the expansion of the support line, midwives will now be able to access the expertise and knowledge of an addiction medicine specialist any day and time of the week.”

Vancouver Island midwife Lorna McRae says pregnant women who use substances feel very stigmatized, and worried about how they are going to be perceived when they present for care.

She added that this can be harmful because the focus shifts away from the health effects of using substances while pregnant.

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“Things like, explaining to people about how (their) blood vessels constrict and then dilate depending on what they’re using and the safety around safe use and harm reduction isn’t very clearly in the health field as much as it should be, I think,” McRae said. “Things like how to mitigate the harmful effects on the growing fetus and on the person’s body themselves. It’s not just about the baby, it’s about the whole person as well as the growing fetus.”

She added, “I think it’s very hard to go for help when they’re worried about a lot of negative judgement on their actions. And they feel pretty negative themselves about those actions. I think this new B.C. service as well as what I’ve seen in the last 20 years of working in this field, I think it’s getting much better in terms of people trying to ensure that people are welcomed into care and that’s the best thing we can do, is try to provide better healthcare.”

The province says supporting clinicians with specific tools and knowledge to approach substance-use care for clients during pregnancy,  will improve overall health outcomes and a better likelihood of longer-term engagement in care.

“This vulnerable time for new parents and their babies is made even more difficult by the stigma that still surrounds substance use,” said Sheila Malcolmson, Minister of Mental Health and Addictions. “This expansion of support will help foster a healthier environment at a time when new parents and their babies need it most.”

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The province says the guideline supplement and expansion of the support line will help reduce barriers of care, while providing supports for clinicians to address substance use safely and effectively with their patients during pregnancy and post-partum periods.

McRae says she has experience helping expectant moms who are substance users.

“First of all, we welcome them into our care, and ensure that they get both the midwifery care as well as any specialist care that they might need so things like making sure they have appropriate ultrasounds and probably some extra ultrasounds, hook them up with resources in the community,” McRae said.

“In Victoria, we have HerWay (Home) services as well as there are umbrella and different substance use treatment programs, there’s a group of GPs that are now doing perinatal substance use stabilization and treatment, so that’s very helpful. We see them whenever they come into the clinic.”

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McRae said midwives will also go out to see substance users who are pregnant to “really try to welcome them in and make sure they have food – we have snacks in our clinic.”

The new clinical guideline is a supplement to the Provincial Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder. 

It was developed by BCCSU in collaboration with Perinatal Services BC, to provide population-specific treatment recommendations and care principles for pregnant and post-partum women who may continue to engage in high-risk drinking and those with alcohol-use disorder. 

The guideline supplement includes current research and outlines steps for routine and repeat screening for alcohol use and alcohol-use disorder, brief counselling interventions and clinical management options for alcohol-use disorder in pregnancy.

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Approaches that support immediate post-partum care and breastfeeding are also included.

The Provincial Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder was released in December 2019 to provide evidence-informed recommendations to health-care providers on how to treat and support people struggling with alcohol use, ensuring that people receive the care they need and deserve. 

In January 2021, Health Canada announced new funding for the BCCSU to adapt this work and develop the first National Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder.

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