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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Diagnosing uncertainty, producing neonatal abstinence syndrome
Amy Chandler1, Anne Whittaker2, Sarah Cunningham-Burley3
1School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
Insights
Neonatal abstinence syndrome (NAS) care involves significant uncertainty for parents and professionals. A social diagnosis approach and relationship-based care can reduce marginalization for parents using drugs during pregnancy.
Area of Science:
- Public Health
- Sociology
- Neonatal Care
Background:
- Substance use during pregnancy presents a significant public health challenge.
- Neonatal Abstinence Syndrome (NAS) is a key manifestation and response to this issue.
- Existing approaches to NAS are marked by uncertainty for families and practitioners.
Purpose of the Study:
- To explore the uncertainties surrounding the anticipation, identification, and response to NAS.
- To propose a framework for understanding and managing NAS that mitigates parental marginalization.
- To advocate for relationship-based care models in managing NAS.
Main Methods:
- Qualitative study involving interviews with 16 parents of infants at risk of NAS.
- Multidisciplinary focus groups with 27 health and social care professionals in Scotland, UK.
- Analysis drawing on social diagnosis and political ontology concepts.
Main Results:
- Parents and professionals experience considerable uncertainty in managing NAS.
- UK parents using opioids face risks of child custody loss, surveillance, and marginalization.
- Current NAS management can exacerbate parental marginalization.
Conclusions:
- Viewing NAS as a social diagnosis can inform more equitable clinical and social responses.
- Relationship-based care can empower service users and providers to challenge existing practices.
- Adopting a social diagnosis framework and relationship-based care can reduce marginalization of parents using drugs.
Abstract:
The use of alcohol and other drugs during pregnancy is understood to be an important public health problem. One way in which this problem is expressed and responded to is via the identification and treatment of neonatal abstinence syndrome (NAS). In this article, we demonstrate how the processes of anticipating, identifying and responding to NAS are characterised by significant uncertainty among parents and health and social care practitioners. We draw on interviews with 16 parents who had recently had a baby at risk of NAS, and multidisciplinary focus groups with 27 health and social care professionals, held in Scotland, UK. NAS, and drug use in pregnancy, is a fraught and complex arena. Parents in the UK who use opioids risk losing custody of children, and must navigate a high degree of surveillance, governance and marginalisation. We suggest that considering NAS as a social diagnosis, further informed by Mol's political ontology of 'multiple' bodies/diseases, may help to produce clinical and social responses to uncertainty which avoid, rather than promote, further marginalisation of parents who use drugs. One such response is to develop a culture of relationship-based care which empowers both service providers and service users to challenge existing practice and decision-making.
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