Objectives

Antenatal care plays a critical role in the prevention and reduction of the obstetric and neonatal complications associated with substance use in pregnancy. In response to recommendations made by the New South Wales (NSW) Ombudsman, the NSW Health Mental Health and Drug & Alcohol Office (MHDAO) undertook a statewide review of drugs in pregnancy services between August 2007 and March 2008. The aim of the review was to identify: (1) the availability of antenatal and postnatal drugs in pregnancy services, (2) access and entry points to treatment and maternity services, (3) assessment and referral pathways and (4) gaps and barriers in the provision of drugs in pregnancy services.

Methods

This comprehensive review of drugs in pregnancy services involved a literature review, extensive site visits and consultations with Area Directors of drug and alcohol services, maternity and drug and alcohol clinicians and a review of submissions from non-government service providers.

Results

In many Area Health Service sites there was evidence of outstanding collaborative multidisciplinary services providing high quality care. However, the audit identified scope for improvement, specifically the need to: (1) improve access to drugs in pregnancy services, (2) develop consistent assessment and referral protocols, (3) develop minimum standards for the provision of drugs in pregnancy services and (4) the need to improve NSW data collections.

Conclusions

At a statewide level, standardised, easy to administer and comprehensive drug and alcohol assessments to improve identification, referral and treatment uptake, need to be developed and implemented. The review highlights the need for improved methods of data collection to ensure that comprehensive population-level data on substance use during pregnancy is routinely collected, and readily accessible. Information from the review will be used by MHDAO to develop and introduce minimum standards for the provision of drugs in pregnancy services across NSW.