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Access to Health Services

Swensen, G, Murdoch, J, Porter, L & Charlton, R M (1989)
Submission to the Task Force to Review the Obstetric, Neonatal and Gynaecological Services in Western Australia.

The submission is a valuable snapshot of treatment involving the use of methadone as an evidence-based approach to provide stability and certainty for the course of a woman’s pregnancy and to build a framework for improved health outcomes during the antenatal stage for the baby and engagement with the health system in the post-natal stages.

As elaborated in more detail in the submission, pregnancy for the heroin-using woman usually constitutes a crisis – the pregnancy is unplanned and discovered some months after conception. 

By the time the woman may present for treatment there has often been ambivalence about the pregnancy, and this is compounded by guilt of using drugs which the woman believes may have harmed the fetus. 

A number of women express the intention to be opiate-free during pregnancy, however this is often a difficult decision to sustain unless the woman has sufficient interpersonal skills to negotiate such a lifestyle with a partner’s support.

The advantages of a low dose methadone support program include minimal withdrawals experienced by the baby at birth and the reduction in the possibility of premature labour as well as providing the woman with a sufficient degree of intoxication to reduce craving for heroin. 

We also strongly encourage women to continue with methadone treatment after the birth to ensure parental stability and social functioning is maximized. Breast feeding is strongly encouraged for women on methadone.

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