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COCAINE & UNBORN BABY.

Effects of drug use on mother & fetus, user profile, physical & behavioral impact, home nursing intervention.

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COCAINE & THE UNBORN BABY
Introduction
This research discusses cocaine use during pregnancy. High rates of drug abuse by women during childbearing ages are reported; children born to these women are vulnerable to the effects of this abuse. An understanding of the effects of drug abuse on both the mother and the child, during and after pregnancy, is necessary. Preventative interventions need to be developed for this problem, and nurse home interventions are considered.
Mother & Child Effects
Reports indicate that tremendous numbers of mothers and infants are affected by substance abuse; dysfunctional families with medical and socioeconomic problems are found, which appear

F. COCAINE & THE UNBORN BABY Introduction This research discusses cocaine use during pregnancy. A history of poor parentalupbringing, poverty, and substance abuse within the family stresses thecapacity to cope with the needs of a child. Black, Nair, Kight, Wachtel, Roby, and Schuler (1994) investigatedthe effects of home intervention on parenting and development of childrenof drug-abusing women. Cocaineabuse during pregnancy is associated with hematuria, proteinuria, hemolyticanaemia, renal impairment, thrombocytopenia, and pulmonary oedema(Campbell, Parr, & Shutt, 1996; Zaichkin & Houston, 1993). The pregnant woman may not evensuspect pregnancy for several months since tendencies for menstrualdysfunction may be typical. The pregnancy may be viewed as a burden; guilt for hurting thebaby with drug use may result with more drug use (Zaichkin & Houston,1993). The woman dependent on drugs has the following characteristics: "lowself-esteem and self-confidence; poor coping skills; multiple social,family, and interpersonal problems; and evidence of increased depressionand anxiety" (p. Cocaine-exposed pregnant women demonstrate increased risk ofintrauterine growth retardation, preterm labor and delivery, spontaneousabortion, abruption, poor maternal weight gain, transient hypertension andtachycardia, and inadequate prenatal care. M., Nair, P., Kight, C., Wachtel, R., Robby, P., & Schuler,M. 43).Infants are at high risk to develop sudden infant death syndrome. 43). Data from the 199 Household Survey on Drug Abuse, by the National Institute on Drug Abuse(NIDA), showed 6 million women of childbearing age (15 years to 44 years)in the United States. Studies show that pregnant women who repeatedly use cocaine have anincreased risk of intrauterine growth retardation, preterm labor anddelivery, spontaneous abortion, abruption, poor maternal weight gain,transient hypertension and tachycardia, and inadequate prenatal care. Women addicts may resort to lying, stealing, and deceiving to meetdrug needs. The drug-exposed mother andinfant: A regional center experience. J., & Shutt, L. A randomized clinical trial of 6 drug-abusingwomen was performed. More studies show the adverse effects ofmaternal cocaine use than show no adverse effects. The child may presentadditional stressors such as congenital anomalies associated with prenatalcocaine abuse. British Journal of Anaesthesia, 77(4),553-555. Journal of Pediatric Nursing, 1 (6), 375-382. Conclusion Studies show that large numbers of mothers and infants are affectedby substance abuse; adverse effects of maternal cocaine use are found.Homelessness, financial problems, poor health, lack of social support,legal entanglements, and loss of children to foster care are presentingproblems. O., & Lobo, M. Drugsmay appear to provide an escape from daily pressures or overwhelmingexperiences; many women begin substance abuse with prescription drugs.Adolescent women may use drugs as an accepted or learned behavior; drugscommonly used by this age group are alcohol, marijuana, and cocaine,particularly crack (Zaichkin & Houston, 1993). Nurses tryand comfort the infant by modulating the environment with decreased visualand auditory stimulation, and comforting techniques; pharmacologicintervention may be needed for irritability, compromised cardiorespiratorystatus, inabilities to feed and sleep, or for seizures (Zaichkin & Houston,1993). These women usually have no experience of positiveparenting for themselves, and many report physical and sexual abuse aschildren and adults. Infantbehaviors may include crying or screaming, trouble sleeping, stiffness andtrembling, poor feeding, spitting up or vomiting, sneezing, stuffiness, andtrouble breathing, frantic sucking of fists, and skin damage. Cocaine abuse during pregnancyis associated with hematuria, proteinuria, hemolytic anaemia, renalimpairment, thrombocytopenia, and pulmonary oedema. The therapeuticrelationship is critical to facilitate communication between the mother andthe infant. Themost common effects of cocaine exposure in newborns includes the following: decreased birth weight, head circumference, length, and Apgar scores; perinatal infections including sexually transmitted diseases; impairment in interactive and organizational abilities; neurophysiologic abnormalities; poor feeding; prematurity; and congenital urogenital anomalies (Zaichkin & Houston, 1993, p. Cocaine exposure innewborns results in effects such as decreased birth weight, headcircumference, length, and Apgar scores, perinatal infections, interactiveand organizational ability impairment, neurophysiologic abnormalities, andcongenital urogenital anomalies. After birth, continuing care of the infant is needed. The client may deny effects ofsubstance abuse on the fetus; facing an inconsolable or critically illinfant may result in feelings of guilt and anxiety. The nurse must facilitate the mother-infant bonding process to assistthe development of appropriate parenting skills. Homelessness, financial problems, poor health and nutrition,lack of social support, legal entanglements, loss of children to fostercare, and threat of abuse may be found. Pediatrics, 94(4), 44 -448. An understandingof the effects of drug abuse on both the mother and the child, during andafter pregnancy, is necessary. Drug abuse is found not only inwomen of lower socioeconomic class; more women from middle and uppersocioeconomic groups are found entering drug and alcohol rehabilitationprograms (Zaichkin & Houston, 1993). Nurses provide information, practical assistance, andsupport needed for these circumstances (Johnson & Lobo, 1995). References Black, M. Childrendemonstrate better cognitive development during infancy. Problems such as hepatitis, adult-onsetdiabetes, hypertension, urinary tract infection, or sexually transmitteddisease, rather than suspected pregnancy, may lead her to seek medicalattention. Neonatal Network, 12(3), 41-49.----------------------- 1 Nurses provide health management of the mother and child of substanceabuse; they provide information, practical assistance, and support needed.Women receiving home nurse visits demonstrate more responsible behavior inreducing drug abuse, complying with care appointments, and providing aresponsive and stimulating environment for the children. Caution is recommended regarding optimism ofhome intervention and promoting positive behaviors for the extremely high-risk women (single, low income, African-American, polydrug abusers). E. Consequences of prenatal drug abuse are considered devastating. (1993). The infant may bedifficult to console and the mother may interpret this behavior asrejection or failure; the nurse needs to educate the mother on these andother issues. Case study of the home healthmanagement of a child with congenital anomalies associated with prenatalcocaine abuse. Messmer, P., Meehan, R., Gilliam, N., White, S., & Donaldson, P.(1993). Women receiving more visits were more likely to comply.Children in the intervention group demonstrated better cognitivedevelopment during infancy. The nurse models appropriate behavior such as caregiving andcomforting the infant; emphasis on the infant's strengths andresponsiveness to comforting encourages parental involvement as caretakerand protector (Zaichkin & Houston, 1993). Mother & Child Effects Reports indicate that tremendous numbers of mothers and infants areaffected by substance abuse; dysfunctional families with medical andsocioeconomic problems are found, which appear to present many obstaclesfor the intervening nurse. A team of medical, psychological, social services, and legalpersonnel is necessary to help the woman get food, transportation, babysupplies, and at times a place to live; the nurse frequently serves as casemanager (Zaichkin & Houston, 1993). (1994). The Inspector General of theOffice of Health and Human Services estimates that 1 , infants eachyear are exposed to cocaine in utero. Campbell, D., Parr, M. Zaichkin, J., & Houston, R. Infantsare assessed for gestational age, respiratory distress, and congenitalanomalies; priorities for the infant include thermoregulation, respiratorystabilization and oxygenation, cardiovascular status and perfusion, andglucose screening (neonatal seizures may be present due to abrupt drugwithdrawal). Women received biweekly home visits from a nurse,beginning before delivery and extending through 18 months of life.Intervention goals were to provide maternal support, promote parenting andchild development, and to use informal and formal resources and advocacy.Results showed that women in the intervention group reported moreresponsible behavior in reducing drug abuse, complying with careappointments, and providing a responsive and stimulating environment forthe children. Of these women, 5 .8 percent used alcohol, 29percent smoked cigarettes, 8 percent used illicit drugs, 6.5 percent usedmarijuana, and 3.5 percent used cocaine. The drug-exposed infant is at a high risk for hepatitis Bvirus (HBV) (Messmer, Meehan, Gilliam, White, & Donaldson, 1993; Zaichkin &Houston, 1993, p. Unrecognized"crack" cocaine abuse in pregnancy. Preventative interventions need to bedeveloped for this problem, and nurse home interventions are considered. Teaching infant CPR to mothers of cocaine-positive infants.Journal of Continuing Education in Nursing, 24(5), 217-22 . Psychiatric disorders include schizophrenia, phobias,passive-aggressive personality disorder, and antisocial behaviors. Johnson, M. Parenting and early development among children of drug-abusingwomen: Effects of home intervention. Intervention Nursing has a pivotal role in the home health management of themother and child of substance abuse. (1996). L. (1995). Mostof these women start with poor health, seek little or no prenatal care, andrisk exposure to contaminants from street drugs and infection. High rates ofdrug abuse by women during childbearing ages are reported; children born tothese women are vulnerable to the effects of this abuse. Nurses face particular challenges when working with chemicallydependent mothers and their infants. 42).

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