JAKE* WAS TWO-weeks-old when he died. His mother Jackie* and her family had been referred to the child and family agency, Tusla, during her pregnancy with Jake because of reported concerns about her drug use and the potential impact on her unborn baby.
There had been an earlier referral during Jackie’s previous pregnancies, but this was closed as no concerns were found to exist at that time. A number of professionals had been involved, including the social work department, the public health nurse, the maternity hospital’s antenatal clinic and a local addiction service.
Jackie had a history of heroin use and had been taking methadone for a number of years. During her previous pregnancies, Jackie had decreased her methadone intake in order to reduce its potential impact on her babies.
While carrying Jake, however, she was struggling with her addiction and screenings taken regularly during her pregnancy were positive for opiates. It was also reported that she was underweight and looked unwell. An incident of alleged neglect of her young child had also been reported.
The social work department made an initial decision that it did not have the resources to follow the referral up immediately but asked the public health nurse to call in. They reported that while Jackie seemed vulnerable and under pressure, her children were doing well.
A social worker made contact with Jackie seven weeks after the referral and eventually met her with her partner and children. This worker kept in regular contact, though the pregnant woman and her partner were resistant to social work contact, claiming that it was upsetting them and putting them under pressure.
High blood pressure
Jackie did minimise her opiate use. While the couple had good support from relatives in the area, neither extended family was aware of Jackie’s drug use and the couple were anxious this information should not be shared with family members.
Concerns remained over the following months as screenings continued to be positive for opiates and Jackie was admitted to hospital with high blood pressure. The baby was observed to be “hyper” and Jackie was agitated during her admission, requiring her methadone dose earlier than normal.
Two weeks before Jake’s birth, a child protection conference was held, attended by both parents. By this stage, Jackie’s regular screenings were negative for opiates and her attendance at clinics was consistent. A plan was included in the child protection conference minutes, including the decision to transfer the case to the further assessment team and address concerns related to the woman’s drug use.
There were also plans to make unannounced home visits to assess the family routine and structure and to provide support.
Two weeks later, Jake was born with a congenital defect and another two weeks later the baby boy died. The pathologist who conducted the post-mortem did mot mention maternal drug use in his findings.
‘Unacceptable slow’
A review of Jake’s case found that the initial response of the social work department, which took seven weeks to make contact with the family, was “unacceptably slow given the circumstances”.
However, it noted that once contact was established, the social worker was “diligent in her efforts to work with the family”.
The National Review Panel (NRP) said this case raises issues about the right of individuals to self-determination and the extent to which the State may intervene when it perceives an unborn child to be at risk.
“The social work department was not able to take any coercive action in this case, despite their serious concern for Jake’s health and welfare,” the report said.
It said the department had “little option but to encourage Jackie, as far as possible, to comply with the drug treatment service and the guidance of her medical advisors”.
The report recommended that Tusla promote the establishment of a nationwide drugs liaison midwife service. An expansion of the role of the drug liaison midwife was included in the government’s recently launched drug strategy, which will result in the creation of seven new midwife posts to assist pregnant women with addiction issues.
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