In the United States, 1 in 300 children are born craving because their mother used drugs or medication during her pregnancy. A situation however avoidable as shown by an Alsatian network.
Tremors, uncontrolled muscular contractions, vomiting, convulsions, respiratory distress… All these signs reflect the state of withdrawal in an addict deprived of his drug. But this withdrawal syndrome can also occur in newborns. When her mother has consumed psychoactive substances during the pregnancy, whether drugs or certain drugs derived from morphine, childbirth corresponds for the newborn to abrupt withdrawal. According to a study published in the prestigious Journal of the American Medical Association, the number of children victims of this neonatal withdrawal syndrome increased from 1 per 1000 births in 2000 to 1 per 300 births in 2009. According to the authors, the 5-fold increase in the number of pregnant women using opiates, i.e. heroin or high doses of painkillers containing morphine, codeine or tramadol over the same period.
In France, the phenomenon is difficult to quantify. The French Office for Drugs and Drug Addiction estimates that 230,000 people, men and women alike, used heroin during 2011. And no precise data is available on the abuse of anti-drug drugs. pain. The secure prescriptions on which these kinds of drugs are prescribed are supposed to limit falsifications and abusive renewals. They probably explain why opiate addiction seems less common in France than in the United States.
But the phenomenon still exists and French maternity hospitals must take care of these women and their high-risk pregnancies. The first difficulty is to identify these women.
Dr Fanny Molière, psychiatrist in the psychiatric emergencies of the University Hospital of Montpellier: ” Drug abuse is even harder to detect than heroin use “
A third of these women have never discussed their addiction with a health professional. The subject is even more guilty and difficult to confide once they are pregnant. It is the midwife, even more than the attending physician, who will be able to forge a relationship with them centered on the baby and succeed in detecting addictive use.
Dr Fanny Molière, psychiatrist at the Psychiatric Emergencies of the Montpellier University Hospital: ” The midwife is the provider of choice for screening for these abuses “
It is also necessary that midwives be made aware of the issue of drug addiction. This is one of the missions of Alsatian Maternity & Addictions network. “It’s a real change in mentality,” explains Maïca Reichert, midwife and network coordinator. From the moment you are trained, the maintenance of the 4e month of pregnancy is really a good time to spot opioid use ”. At the Bas-Rhin level, around sixty pregnant women dependent on opiates are cared for each year by the network which brings together midwives, gynecologists, general practitioners, psychiatrists, pediatricians and social workers. There are few similar structures in France, apart from a pioneering hospital unit at the Montpellier University Hospital. The few specialists are therefore called upon everywhere in France, in particular to intervene during training courses for birth professionals.
Whether it is heroin use or the abuse of analgesic drugs, the technique is the same. The mother should be offered a replacement drug, buprenorphine or methadone, until the end of her pregnancy, but especially not weaning.
Maïca Reichert, midwife and coordinator of the Maternity & Addictions network: “ The lack causes contractions and premature labor “
At the time of birth, it is essential not to separate the newborn from its mother. In the newborn, this would increase the intensity and duration of withdrawal symptoms and in his mother, there is a risk of reinforcing his anxiety and his feeling of guilt. The Alsatian network therefore recommends the use of kangaroo units because most of the treatment of neonatal withdrawal syndrome involves the carrying and reassurance of the child by its mother.
Maïca Reichert, midwife and coordinator of the Maternity & Addictions network: “ This avoids having to resort to drug treatment of the newborn. “
Because it is better anticipated, the method recommended by the Alsatian network has another major advantage: the length of hospitalization for infants and their mothers is reduced to 8 days on average. Either half of that observed by the authors of the American study. They estimate the annual hospital cost of neonatal withdrawal syndromes at $ 720 million in the United States. An argument that the Alsatian network will not fail to make to the Regional Health Agency to perpetuate this mission.
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