University of Stirling, Scotland, UK; NHS Lothian, Scotland, UK.
University of Edinburgh, Scotland, UK.
Int J Drug Policy. 2019 Jun;68:139-146. doi: 10.1016/j.drugpo.2018.06.006. Epub 2018 Jul 17.
Neonatal Abstinence Syndrome (NAS) is an anticipated effect of maternal drug use during pregnancy. Yet it remains a contested area of policy and practice. In this paper, we contribute to ongoing debates about the way NAS is understood and responded to, through different treatment regimes, or logics of care. Our analysis examines the role of risk and recovery discourses, and the way in which the bodies of women and babies are conceptualised within these.
Qualitative interviews with 16 parents (9 mothers, 7 fathers) and four focus groups with 27 health and social care professionals based in Scotland. All the mothers were prescribed opioid replacement therapy and parents were interviewed after their baby was born. Data collection explored understandings about the causes and consequences of NAS and experiences of preparing for, and caring for, a baby with NAS. Data were analysed using a narrative and discursive approach.
Parent and professional accounts simultaneously upheld and subverted logics of care which govern maternal drug use and the assessment and care of mother and baby. Despite acknowledging the unpredictability of NAS symptoms and the inability of the women who are opioid-dependent to prevent NAS, logics of care centred on 'proving' risk and recovery. Strategies appealed to the need for caution, intervening and control, and obscured alternative logics of care that focus on improving support for mother-infant dyads and the family as a whole.
Differing notions of risk and recovery that govern maternal drug use, child welfare and family life both compel and trouble all logics of care. The contentious nature of NAS reflects wider socio-political and moral agendas that ultimately have little to do with meeting the needs of mothers and babies. Fundamental changes in the principles, quality and delivery of care could improve outcomes for families affected by NAS.
新生儿戒断综合征（NAS）是母亲在怀孕期间使用药物的预期影响。然而，它仍然是政策和实践争议的领域。在本文中，我们通过不同的治疗方案或护理逻辑，为正在进行的关于 NAS 的理解和应对方式的争论做出贡献。我们的分析考察了风险和恢复话语的作用，以及这些话语中妇女和婴儿身体的概念化方式。
对 16 名父母（9 名母亲，7 名父亲）和 4 个来自苏格兰的 27 名卫生和社会保健专业人员进行了定性访谈。所有母亲都接受了阿片类药物替代疗法治疗，并且在婴儿出生后对父母进行了访谈。数据收集探讨了对 NAS 的原因和后果的理解，以及对准备和照顾患有 NAS 的婴儿的经验。使用叙述和话语方法对数据进行了分析。
父母和专业人员的叙述同时支持和颠覆了管理母亲药物使用以及评估和照顾母亲和婴儿的护理逻辑。尽管承认 NAS 症状的不可预测性以及依赖阿片类药物的妇女无法预防 NAS，但护理逻辑仍集中在“证明”风险和恢复上。策略呼吁需要谨慎、干预和控制，并掩盖了关注改善母婴对子和整个家庭的支持的替代护理逻辑。
管理母亲药物使用、儿童福利和家庭生活的不同风险和恢复观念既迫使又困扰着所有护理逻辑。NAS 的争议性质反映了更广泛的社会政治和道德议程，这些议程最终与满足母亲和婴儿的需求关系不大。护理原则、质量和提供方式的根本改变可以改善受 NAS 影响的家庭的结果。
