Evaluative Case Study: Pregnancy, Addiction, and Treatment Options

This evaluative case study examines the case of Ms. Robertson, a pregnant woman with a history of opioid addiction, homelessness, and Hepatitis C. The study details her situation, history of substance abuse including cannabis and morphine, and the assessment conducted at the hospital, including suspected SROM and intrauterine growth restriction. The assignment explores the importance of antenatal care and psychological assessments, referencing the Edinburgh Postnatal Depression Scale. The treatment plan includes referral to the Safe Start program and MUMS (Mums Using Methadone Services), along with methadone and Subutex prescriptions. The case study provides evidence of the prevalence of psychiatric disorders and the challenges faced by women with substance abuse issues during pregnancy, including the risks of obstetric complications such as low birth weight and preterm births. The conclusion emphasizes the crucial role of midwives in providing continuous care and the necessity of proper methadone treatment and anti-addiction therapies.

Running head: EVALUATIVE CASE STUDY
Evaluative Case Study
Name of the Student
Name of the University
Author Note

EVALUATIVE CASE STUDY
Table of Contents
Introduction................................................................................................................................2
Discussion..................................................................................................................................3
Situation:................................................................................................................................3
History:...................................................................................................................................3
Assessment:................................................................................................................................4
Rx/Treatment:.............................................................................................................................5
Evidence:................................................................................................................................6
Evaluation..................................................................................................................................6
Conclusion..................................................................................................................................7
References..................................................................................................................................9

EVALUATIVE CASE STUDY
Introduction
For more than a decade, methadone has been used for the treatment of the opiate-
addicted individuals for separating them from their addiction to morphine, heroin and other
opioids.Methane is a synthetic narcotic which interferes with the capability of the heroin to
focus dopamine receptors inside the brain.The use of methadone helps in controlling the drug
addicts from further harming themselves.The opioid use in the time of pregnancy has
increased rapidly in the current years which in turn as risen the chances of the epidemic in the
women of the general population. According to the report of Australian helath department
conducted by the Australian Bureau of Statistics ,more than 41.6% of women in the current
era are diagnosed with the addiction of drug and alcoholism during and before their
pregnancy. not only women, specifically preganant women, but also infants and kids are
affected due to such substance abuse through out the world and among different race and
ethinicity. therefire, it is necessary to carry out screening It should be an essential part of the
comprehensive obstetric care and it should be done in the first parental visit with the woman
who is undergoing the pregnancy. Multidisciplinary follow-ups must include developmental,
medical and social supports (The Royal College of Midwives, 2012). Neonatal abstinence
syndrome. can alkso help to diagnose the use of opoids while pregnancy as the women who
uses such service whie pregnancy develops the sympotoms of the syndrome. It has often been
found that proper universal screening, brief intervention, and treatment referral for pregnant
women with the use of opioid improve and develop outcomes regarding infants and maternal
health. Besides the psychological benefits, the treatment related to methadone is one of the
best methods for the treatment of opioid dependence due to its pharmacokinetic properties.
Some of the other benefits of the treatment are that the methadone is generally active when
they are taken orally, furthermore, it is associated with fewer and lower sedating and euphoric

EVALUATIVE CASE STUDY
effects that antagonize that effects of other opioid medications. But too much use of the
methadone drugs during pregnancy tends to cause preterm labor and the neonate with very
low birth weight, it further tends to cause development delays among neonate.Too much use
of drugs during pregnancy is harmful to the foetus.
Discussion
(S) Situation:
The situation explains the case of Ms. Robertson who is a homeless person who
currently seeks diagnosis and helo to the emergency of the Tweed Hospital being pregnant
for 36 weeks.The hospital suspected SROM, signs of opioids withdrawals and Hepatitis C
positive in Ms. Robertson.Furthermore, she was not treated with any antenatal care and was
suspected intrauterine growth restriction.She was transferred to the daily assessment unit of
the women’s care at the hospital for a proper assessment of pregnancy.
A midwife noticed that the foetus of Ms. Robertson was measuring around 32 weeks.
Besides she came to know that Ms. Robertson has been using 100 mg illicit morphine on a
daily basis and was smoking 10 cannabis cones daily in the past years. After successful
consultation with the midwife, Robertson was sent for a growth scan USG for the effective
access to the condition of the foetus. Furthermore, she was recommended to immediately
contact the opioids treatment services for the replacement of the opioid therapy.
(H) History:
Ms. Robertson was raised and abandoned by her parents who had a history of
problematic substance abuse.Her parents were alcohol users, opioid and chronic cannabis.
According to reports, the patient started using cannabis at the age of 8 and morphine at the

EVALUATIVE CASE STUDY
age of 16. Since then the use of these substances and other opiates has been a bigger issue
that results in an increased tendency of criminal behaviorin her personality. further issues
related to health like custodial sentences also increased. Furthermore she suffered from
anxiety from 10 years and used alprazolam from a very young age.
In connection with the given case study, Ms. Robertson has an extensive history of the child
abuse. According to the study, she has been the victim of sexual abuse by her father from the
tender age of five at repetitive occasions. According to the reports and explanation by the
World Health Organization, child abuse is defined as the forced involvement of a child in any
sexual activity that she is unable to comprehend (World Health Organizaton, 2018). The
abuse is evidenced generally among the child and an adult who is generally in the
relationship of responsibility, power, and trust. It has been seen that children who are exposed
to traumatic experiences often tends to encounter issues throughout their life from childhood
through adolescence to their adulthood (Jonson-Reid, Kohl & Drake, 2012).
(A) Assessment:
Ms. Robertson stated that she was not given any treatment or medicines when she was
pregnant.She further stated her fear and anxiety over the safety from her ex-partner who had
the history of domestic violence an drug abuse.
The assessment of antenatal psychology of pregnant women is one of the most
important roles for the midwives. According to the National Perinatal Mental Health Action
Plan by the Commonwealth Government, it is important to assess the mental, psychological
and wellbeing of the many women undergoing the perinatal period(MCCAULEY et
al., 2011).According to this plan, all women should be assessed in pregnancy and postnatally
for ensuring that proper referral is made towards the mental health care professional. One of

EVALUATIVE CASE STUDY
the proposed tools for the baseline assessment is the Edinburgh Postnatal Depression Scale
(Shiu & Ensom, 2012).
(R) Rx/Treatment:
After the birth of her baby, Ms Robertson was referred to the Safe Start programme as
one of the essential parts of her treatment plan. The Safe Start programme focuses on helping
the vulnerable or the risky families during the time of pregnancy.Furthermore, she expressed
interest to join the Mums Using Methadone Services (MUMS) at the hospital.MUMS is
generally the service targeting the pregnant women who are under the methadone treatments
and have a history of drug and alcohol intakes.Ms. Robertson was suggested to join the
program in the context of her treatment that aims to help her reduce the harm or the risk to
her and her neonate.As the essential part of her treatment plan, Robertson was referred to a
self-referral treatment plan that aims to improve her psychological characteristics and her
nature of substance abuse by social constructivism and normalizing behaviors.Ms. Robertson
was further prescribed to visit a methadone and opioids clinic to receive medication based
therapies for abolishing the addiction of her towards the opioid-based drugs and alcohol.
Treatments such as MUMS /DIPS Programme (ROSH ASSESSMENT) which prohibits the
risks of the significant harm to the women bearing a child was suggested to Ms. Robertson as
the plan for her diagnosis treatment.Lastly, Ms. Robertson was prescribed to intake Subutex
pill for treating her addiction and dependence to the opioids.
(E) Evidence:
One of the highest prevalent diseases among the women during their childbearing
years is the psychiatric disorders. Among 80.46% of the women who had the history of drug

EVALUATIVE CASE STUDY
addiction and alcohol dependence reported not to receive any care and treatment during her
pregnancy. Furthermore, it has also been seen that these women often tend to have
psychological issues of substance abuse and often the child protection services of the state
separates and removes their children from them in the inspection of their vulnerable nature
and drug addictions (Jonson-Reid, Kohl & Drake, 2012). It has often been seen that women
with serious mental illness experiences lower rates of antenatal care since the fear of
encountering stigma and the judgmental attitudes of the healthcare professionals are still
prevalent in the society (RANZCOG College, 2016). This often results in the relapse of their
mental illness together with difficulties in parenting and an increased risk of losing their
children.
Evaluation
The concept of the opoid dependency is a much-recognized phenomenon in the
current decade. Women have been subjected to this disorder for many ages. This disorders
includes issues such as anxiety, post-traumatic stress disorders are higher in chances among
the women in relation to childbirth (Child Welfare Information Gateway, 2013). The impacts
of negative experiences in life on the psychological well-being of the women have the
tendency to the higher risk of obstetric complications. Women experiencing mental illness
generally tend to have the high risk of maternal self-harm, maternal harm towards baby and
impaired relationships among mother and infant.
It has been observed that due to opoid dependency, preganant women develop
psychiatric disorders that enhances the risk of self-har and increases suicidal tendency.
Pregnancy and the postpartum are stages of increased sensitivity to psychiatric disorders
which may confound treatment of substance abuse. It has been observed that more than 60%

EVALUATIVE CASE STUDY
of women having opoid dependency suffer from co-morbid psychiatric disorder. women
suffering from substance abuse are at increased risk of psychological distress compared to
women that do not use such products as well as those women are found to have poorer mental
outcomes. There are imperfect data on suggested treatments of psychiatric disorders in
pregnant women with co-morbid opioid dependence. Though, it is recommend that
synchronized management of psychiatric symptoms with treatment of the substance use
disorder can help the women in such situation.
Another most significant issue related to the mental illness is the increased risk of
obstetric complications. Some of the key and basic risk factors of obstetric are an unplanned
pregnancy, hypertension related to pregnancy, cesarean issues and early discharge from
healthcare institutes (NSW DEPARTMENT OF HEALTH, 2009). Some of the related
complications include low birth weight, intrauterine growth retardation, and risks of preterm
births. Researchers revealed the increased risk of complications during the pregnancy and the
neonatal period. It has been noticed that women suffering from affective psychosis and
schizophrenia have the tendency to the risk for complications related to obstetrics.
Conclusion
Midwives hold the power and the opportunity to generate a difference towards the
outcomes for both the baby and the mother. This is because they are enabled and expert in
providing continuous care during this vulnerable time of any women. They are generally
considered with a positive regard by the health care profession which results in the formation
of a deep bond with the women in care. Further education and training regarding the mental
health and mental illness in thus necessary for the midwives. This is because they can assess
the wellbeing of the women who are pregnant and have mental health issues. Drug addiction
is a serious issue and dependence towards frequent alcohol intake and drug addiction has a

EVALUATIVE CASE STUDY
serious impact on the health of the pregnant women and her neonate.Thus the use of
methadone treatment should be properly used in case of pregnancy and the patients should be
diagnosed with anti-drug addiction therapies and treatments.

EVALUATIVE CASE STUDY
References
Australian Bureau of Statistics. (2017, September). 3303.0 - Causes of Death, Australia,
2016. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by
%20Subject/3303.0~2016~Main%20Features~Drug%20Induced%20Deaths%20in
%20Australia~6
Centre for Population Health. (2006, November). Opioid Treatment Program: Clinical
Guidelines for methadone and buprenorphine treatment. Retrieved from
http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2006_019.pdf
Child Welfare Information Gateway. (2013). Long-Term Consequences of Child Abuse and
Neglect. Retrieved from https://www.childwelfare.gov/pubs/factsheets/long-term-
consequences/
HOW TO WORK WITH SURVIVORS OF CHILDHOOD SEXUAL ABUSE (CSA). (2018).
Jonson-Reid, M., Kohl, P. L., & Drake, B. (2012). Child and adult outcomes of chronic child
maltreatment. Pediatrics, 129(5), 839-845.
MCCAULEY, K., ELSOM, S., MUIR-COCHRANE, E., & LYNEHAM, J. (2011).
Midwives and assessment of perinatal mental health. Journal Of Psychiatric And
Mental Health Nursing, 18(9), 786-795. http://dx.doi.org/10.1111/j.1365-
2850.2011.01727.x
NSW DEPARTMENT OF HEALTH. (2009, September). NSW Health Review of Substance
Use in Pregnancy Services. Retrieved from
http://www.health.nsw.gov.au/mentalhealth/programs/da/Documents/review-of-
substance.pdf

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Parolin, M., & Simonelli, A. (2016, August). Attachment Theory and Maternal Drug
Addiction: The Contribution to Parenting Interventions. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004230/
RANZCOG College. (2016, July). Substance-use-in-pregnancy. Retrieved from
https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's
%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Substance-use-in-
pregnancy-(C-Obs-55)-Review-July-2016.pdf?ext=.pdf
Shiu, J. R., & Ensom, M. H. (2012, September). Dosing and Monitoring of Methadone in
Pregnancy: Literature Review. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477836/
The Royal College of Midwives. (2012, November). Maternal Emotional Wellbeing and
Infant Development-A Good Practice Guide for Midwives. Retrieved from
https://www.rcm.org.uk/sites/default/files/Emotional%20Wellbeing_Guide_WEB.pdf
World Health Organizaton. (2018). Child maltreatment-Violence and Injury Prevention.
Retrieved from http://www.who.int/violence_injury_prevention/violence/child/en/