Book Review
Mothers, drugs and babies
David Thomas
ISBN: 086433 0774; 81 pages; MacLennan and Petty, Sydney;
Diana MacNeish
Box Hill Hospital, Box Hill VIC
I am writing this review as a practising midwife in a reasonable sized birthing suite at a public hospital with a level 2 nursery.
This book is a handy size, well printed and laid out, and, at 81 pages, is not too burdensome to read. It is set in Australia, so we don't have to transcribe references from the UK or USA experience, although the author does mention those places, particularly Los Angeles, with its drug problems. It discusses the effect of various drugs on pregnancy, and in the neonatal period. In Washington DC, for example, the infant mortality increased by 50 in the first 6 months of 1989. This was attributed to the widespread use of crack during pregnancy.
The book is easy to read and flows along well, from the chapter on social drugs of abuse to a valuable section on AIDS and to the 'conclusions' drawn by the author. Identifying clues to substance abuse in pregnancy are listed. The author claims that the punitive attitude to drug abuse has failed, and that we need to tackle the problem from the 'other end'. He states that we should try to do something about the social conditions that lead to drug abuse. Many pregnant women who come through the clinic with drug abuse problems have had histories of child abuse, sexual assault and incest.
The methadone maintenance program is described, its methods of treatment, and its advantages. The prejudice against drug abusers who become pregnant is discussed and the common misconception that drug abusing women are relatively infertile.
The chapter on cocaine is interesting: its bad effects were noted over 100 years ago. In 1889 the French physician Magnan, was the first to describe the tactile hallucinations of cocaine addicts who imagined they had insects, known as 'coke bugs' crawling under their skin in 1904, a German physician Albert Stein, described the perforation of the nasal septum and collapse of the nasal bridge following too frequent snorting of powdered cocaine.
The book covers paediatric care and development follow up, together with infection control, education and treatment centres. It discusses the effects of drugs on the neonate, and encourages breast feeding except when the mother is HIV positive and where there is a risk of infection through the breast milk. Sudden Infant Death Syndrome (SIDS), is explored towards the end of the book where the author expresses concern over the relationship between substance abuse and the increased risk of SIDS. The final chapter on AIDS looks at the way it is transmitted and risk to the foetus, together with advice on immunisations.
For the midwife who can't remember which slang or popular name fits with which drug, here is a handy reference. The book will be a useful and easily understood reference for all health care workers.
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